Provider Demographics
NPI:1154426617
Name:ZBLEWSKI, RANDALL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JOSEPH
Last Name:ZBLEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12760 W NORTH AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4628
Mailing Address - Country:US
Mailing Address - Phone:262-439-5500
Mailing Address - Fax:866-439-5221
Practice Address - Street 1:12760 W NORTH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4628
Practice Address - Country:US
Practice Address - Phone:262-439-5500
Practice Address - Fax:866-439-5221
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI246432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B57814Medicare UPIN
001104150Medicare ID - Type Unspecified