Provider Demographics
NPI:1497741409
Name:OREM, RANDALL COREY (DO)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:COREY
Last Name:OREM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8130
Mailing Address - Country:US
Mailing Address - Phone:937-497-1200
Mailing Address - Fax:937-497-7013
Practice Address - Street 1:295 NW PEACOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2212
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH340038490207RC0000X
FLOS15763207RC0000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138305Medicaid
OH0603592Medicaid
OHAD9271091Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
OH0639095Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
OH2138305Medicaid