Provider Demographics
NPI:1215955711
Name:PANIELLO, RANDAL C (MD)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:C
Last Name:PANIELLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7509
Mailing Address - Fax:314-747-5593
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DEPT OTOLARYNGOLOGY, STE 11A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7509
Practice Address - Fax:314-362-7522
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MOR2F79207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202231924Medicaid
ILENROLLEDMedicaid
MO017010206Medicare PIN
IL$$$$$$$$$Medicaid