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General NPI Number Information
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NPI Number | 1205321205
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Entity Type | Individual
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Provider Name | RANDAL DE SOUZA MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 740 S LIMESTONE STE K201
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City | LEXINGTON
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State | KY
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Zip | 40536-2639
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Country | US
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Telephone | 859-323-6211
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Fax | 859-257-0491
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Provider Business Mailing Address
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Address Line | KENTUCKY CHILDREN'S HOSPITAL 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-0001
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Country | US
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Telephone | 859-323-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 60239
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.144506
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License Number State | OH
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