MEDICARE: DR. GUY ROBERT RANDOLPH 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	2080P0202X	Pediatric Cardiology Physician	036100179	IL

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	:	1982660635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUY ROBERT RANDOLPH M.D.

Provider Business Mailing Address
First Line	:	2923 N CALIFORNIA AVE STE 230
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4677
Country	:	US
Telephone Number	:	312-951-5800
Fax Number	:	312-951-5816

Provider Business Practice Location Address
First Line	:	2923 N CALIFORNIA AVE STE 230
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4677
Country	:	US
Telephone Number	:	312-951-5800
Fax Number	:	312-951-5816

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	01/15/2026

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