Healthcare Provider Details

I. General information

NPI: 1649296914
Provider Name (Legal Business Name): RANDY JOHN FOLKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 SPRING VALLEY RD
BURLINGTON WI
53105-7614
US

IV. Provider business mailing address

202 LICHEN DR
CODY WY
82414-5027
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-6020
  • Fax:
Mailing address:
  • Phone: 307-578-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1272
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9739A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number073897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: