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Dr. Kelly Randall, MD
Specialist in Fremont, Ohio
NPI 1982679171

Kelly Randall is a Specialist based in Fremont, OH. Kelly Randall practices in Fremont, OH and has the professional credentials of MD. The NPI Number for Kelly Randall is 1982679171 and holds a License No. 35-04-5927-R (Ohio).

The current practice location address for Kelly Randall is 605 3Rd Ave, Fremont, OH and can be reached out via phone at 419-332-7311 and via fax at 419-332-8552.

Location: 605 3Rd Ave, Fremont, OH, 43420-3269
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1982679171
Provider Name
Kelly Randall
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
605 3Rd Ave, Fremont, OH, 43420-3269
Phone Number
419-332-7311
Fax Number
419-332-8552
Provider Enumeration Date
02/21/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
3413682771923 01 OH NEIC
200001447 01 OH RAILROAD MEDICARE
0491052 05 OH
341368277-00 01 OH WORKERS' COMP
000000131064 01 OH ANTHEM CMIC-TIFFIN
000000350046 01 OH ANTHEM CMIC-FREMONT
institution
Provider Business Practice Location Address Details
Address
605 3Rd Ave
City
Fremont
State
Ohio
Zip
43420-3269
Phone Number
419-332-7311
Fax Number
419-332-8552
person
Provider Business Mailing Address Details
Address
605 3Rd Ave
City
Fremont
State
Ohio
Zip
43420-3269
Phone Number
419-332-7311
Fax Number
419-332-8552
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
35-04-5927-R (Ohio)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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