MEDICARE: RANDI H BACULI MD PA

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	174400000X	Specialist	L2117	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00003881	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7477332	OTHER	TX	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0010PZ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1902837669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDI H BACULI MD PA

Provider Business Mailing Address
First Line	:	2504 FIGTREE LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-4858
Country	:	US
Telephone Number	:	972-423-0977
Fax Number	:	972-578-1867

Provider Business Practice Location Address
First Line	:	9 MEDICAL PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7858
Country	:	US
Telephone Number	:	972-423-0977
Fax Number	:	972-578-1867

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LORNA BACULI
Credential	:
Telephone Number	:	972-423-0977

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/03/2026

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Directions to “RANDI H BACULI MD PA ” Practice Location

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