Healthcare Provider Details

I. General information

NPI: 1386219335
Provider Name (Legal Business Name): OPAL ERIKA RANDOLPH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

IV. Provider business mailing address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

V. Phone/Fax

Practice location:
  • Phone: 810-496-5500
  • Fax: 810-496-5536
Mailing address:
  • Phone: 810-257-3709
  • Fax: 810-257-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101028293
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: