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NPI Code Detail

MEDICARE: MIRANDA RANDOLPH

MEDICARE: MIRANDA RANDOLPH
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1720548506
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA RANDOLPH
Provider Business Mailing Address
First Line : 10100 ELIDA RD
Second Line :
City : DELPHOS
State : OH
Zip : 45833-9058
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11590 CENTURY BLVD STE 116
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-3317
Country : US
Telephone Number : 513-771-7239
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 10/24/2022

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Directions to “ MIRANDA RANDOLPH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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