Provider Demographics
NPI:1861425068
Name:HILE, RANDALL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEE
Last Name:HILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 W 177TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1971
Mailing Address - Country:US
Mailing Address - Phone:219-696-0779
Mailing Address - Fax:219-696-4629
Practice Address - Street 1:1020 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2310
Practice Address - Country:US
Practice Address - Phone:219-696-3052
Practice Address - Fax:219-696-4629
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030234A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110007891OtherRAILROAD MEDICARE
IN200900500AMedicaid
IN000000085930OtherBLUE CROSS BLUE SHIELD
INC25251Medicare UPIN
IN000000085930OtherBLUE CROSS BLUE SHIELD
IN110007891OtherRAILROAD MEDICARE