Provider Demographics
NPI:1205321205
Name:DE SOUZA, RANDAL (MD)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:
Last Name:DE SOUZA
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:KENTUCKY CHILDREN'S HOSPITAL 800 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-5000
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE K201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2639
Practice Address - Country:US
Practice Address - Phone:859-323-6211
Practice Address - Fax:859-257-0491
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY602392080P0208X
OH35.144506208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics