Healthcare Provider Details

I. General information

NPI: 1326253998
Provider Name (Legal Business Name): RANDALL J KIMPLE M.D. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX #647
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

3305 SHADY LN
MADISON WI
53705-1452
US

V. Phone/Fax

Practice location:
  • Phone: 919-672-6976
  • Fax:
Mailing address:
  • Phone: 919-672-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number55003
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: