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General NPI Number Information
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NPI Number | 1942089883
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Entity Type | Individual
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Provider Name | RANDALL SCOTT HIGHBAUGH JR. ATC
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Gender | Male
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 26636 W IAN CT
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City | CHANNAHON
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State | IL
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Zip | 60410-5505
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Country | US
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Telephone | 815-347-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 26636 W IAN CT
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City | CHANNAHON
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State | IL
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Zip | 60410-5505
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Country | US
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Telephone | 815-347-4522
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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 | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | 096003299
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License Number State | IL
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