MEDICARE: CHIYOKO RANDO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085.011954	IL

General Provider Information

NPI Number	:	1073353728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIYOKO RANDO PA-C

Provider Business Mailing Address
First Line	:	3000 N HALSTED ST STE 623
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5196
Country	:	US
Telephone Number	:	773-281-5818
Fax Number	:	773-281-6895

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 623
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5196
Country	:	US
Telephone Number	:	773-281-5818
Fax Number	:	773-281-6895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	01/21/2026

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