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1356393219

NPI Code Detail

MEDICARE: RANDALL LEE OLIVER M.D.

MEDICARE: RANDALL LEE OLIVER 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	207Q00000X	Family Medicine Physician	01029835	IN
2	208VP0014X	Interventional Pain Medicine Physician	1029835	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000089152	OTHER	IN	ANTHEM FAMILY PRACTICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10643	OTHER	IN	HEALTHSOURCE
4	351865226-00	OTHER	IN	PHN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	659100	OTHER	IN	PRINCIPAL
7	0000000386753	OTHER	IN	ANTHEM PAIN MGMT
8	1006173	OTHER	IN	CHAMPUS
9	169425	OTHER	IN	HEALTHLINK

General Provider Information

NPI Number	:	1356393219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL LEE OLIVER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5249
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47716-5249
Country	:	US
Telephone Number	:	812-477-7246
Fax Number	:	812-477-7240

Provider Business Practice Location Address
First Line	:	1101 PROFESSIONAL BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-8016
Country	:	US
Telephone Number	:	812-477-7246
Fax Number	:	812-477-7240

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/16/2024

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Directions to “ RANDALL LEE OLIVER M.D.” Practice Location

Language	Start Address	Practice Location

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