Healthcare Provider Details

I. General information

NPI: 1780161950
Provider Name (Legal Business Name): RANDA AHMED SHARAG ELDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 8TH AVE STE 200B
KENOSHA WI
53143-5031
US

IV. Provider business mailing address

6308 8TH AVE
KENOSHA WI
53143-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-3636
  • Fax: 262-656-3715
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number75132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: