MEDICARE: DR. RANDY MUDGE M.D.

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	2085R0001X	Radiation Oncology Physician	4301057699	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346200573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY MUDGE M.D.

Provider Business Mailing Address
First Line	:	300 NORTH AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3307
Country	:	US
Telephone Number	:	269-245-8056
Fax Number	:	269-966-8593

Provider Business Practice Location Address
First Line	:	300 NORTH AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3307
Country	:	US
Telephone Number	:	269-966-8334
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/13/2020

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