GEOFFREY M RANDOLPH (NPI# 1194726380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194726380 |
| Entity Type | Individual |
| Full Name | GEOFFREY M RANDOLPH |
| Credential | MD |
| Practice Address |
11141 Parkview Plaza Dr Ste 300 Fort Wayne IN 46845-1715 |
| Mailing Address |
7230 Engle Rd Fort Wayne IN 46804-2209 |
| Practice Telephone | 2604907111 |
| Practice Fax Number | 2604909301 |
| Mailing Telephone | 2604907111 |
| Mailing Fax Number | 2604909301 |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2018-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | 01035742A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100353210 | 05 | |
| IN | MEDICARE RAILROAD | 240007528 | 01 |
| OH | 0467338 | 05 | |
| MI | 104366820 | 05 |
| Street Address |
11141 PARKVIEW PLAZA DR STE 300 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46845-1715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124029079 | Guy Gerald Crevecoeur | Plastic Surgery | 11141 Parkview Plaza Dr Ste 300, Fort Wayne, IN 46845-1715 | 2005-08-02 |
| 1326049479 | Albert M Morrison | Plastic Surgery | 11141 Parkview Plaza Dr Ste 300, Fort Wayne, IN 46845-1715 | 2005-08-10 |
| 1164423620 | Kevin L Berning | Plastic Surgery | 11141 Parkview Plaza Dr Ste 300, Fort Wayne, IN 46845-1715 | 2005-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
| 1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
| 1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
| 1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
| 1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
| 1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
| 1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
| Find all providers in zip 46845 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730277583 | Fort Wayne Dermatology Cons. Inc. | Plastic Surgery | 7881 Carnegie Blvd, Fort Wayne, IN 46804-5792 | 2006-10-10 |
| 1508867656 | Brian J Lee | Plastic Surgery | 7910 W Jefferson Blvd Ste 212, Fort Wayne, IN 46804-4159 | 2005-08-10 |
| 1700888617 | Matthew E Shambaugh | Plastic Surgery | 7920 W Jefferson Blvd Ste 200, Fort Wayne, IN 46804-4166 | 2005-08-10 |
| 1124029079 | Guy Gerald Crevecoeur | Plastic Surgery | 11141 Parkview Plaza Dr Ste 300, Fort Wayne, IN 46845-1715 | 2005-08-02 |
| 1881968279 | Aspire Plastic Surgery LLC | Plastic Surgery | 7910 W Jefferson Blvd Ste 212, Fort Wayne, IN 46804-4159 | 2012-03-02 |
| 1013201995 | Reid Robert Pflueger | Plastic Surgery | 7920 W Jefferson Blvd Ste 200, Fort Wayne, IN 46804 | 2011-06-08 |
| 1477622934 | Michael Robert Davis | Plastic Surgery | 7900 W Jefferson Blvd Ste 306, Fort Wayne, IN 46804-4128 | 2006-11-07 |
| 1275624686 | Plastic Surgery Innovations, P.C. | Plastic Surgery | 10215 Auburn Park Dr, Suite B, Fort Wayne, IN 46825-2387 | 2006-09-28 |
| 1033120969 | Robert Nicholas Severinac | Plastic Surgery | 10020 Dupont Circle Ct, Suite 100, Fort Wayne, IN 46825-1620 | 2006-08-09 |
| 1407888589 | James R. Miller | Plastic Surgery | 11141 Parkview Plaza Dr, Suite 305, Fort Wayne, IN 46845-1713 | 2006-07-07 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46845 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.