MEDICARE: DR. RANDAL M SEDLAK MD

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	208600000X	Surgery Physician	00008204	AL

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
2	51089004	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1780733220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDAL M SEDLAK MD

Provider Business Mailing Address
First Line	:	2257 TAYLOR RD
Second Line	:	SUITE 200
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7790
Country	:	US
Telephone Number	:	334-270-9914
Fax Number	:	334-270-3195

Provider Business Practice Location Address
First Line	:	1722 PINE ST STE 503
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1160
Country	:	US
Telephone Number	:	334-264-8741
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	01/23/2019

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