Healthcare Provider Details

I. General information

NPI: 1386694412
Provider Name (Legal Business Name): RANDY C. ASMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12994 BOLDT ROAD
SIDE LAKE MN
55781
US

IV. Provider business mailing address

PO BOX 309
SIDE LAKE MN
55781-0309
US

V. Phone/Fax

Practice location:
  • Phone: 712-209-0355
  • Fax:
Mailing address:
  • Phone: 712-209-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29128
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: