Provider Demographics
NPI:1083663918
Name:MEGEFF, RANDALL A (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:A
Last Name:MEGEFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1001 HEATHER DRIVE
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853
Practice Address - Country:US
Practice Address - Phone:217-586-8400
Practice Address - Fax:217-586-5093
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093784207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103074Medicaid
IL036103074Medicaid
IL6447860010Medicare NSC
ILG50215Medicare UPIN
G50215Medicare UPIN
ILK06160Medicare PIN