Provider Demographics
NPI:1306806567
Name:LAL, RANDHIR A (DPM)
Entity type:Individual
Prefix:DR
First Name:RANDHIR
Middle Name:A
Last Name:LAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 MISTY MORN RD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7824
Mailing Address - Country:US
Mailing Address - Phone:561-586-8313
Mailing Address - Fax:561-323-4999
Practice Address - Street 1:5216 MISTY MORN RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-7824
Practice Address - Country:US
Practice Address - Phone:561-586-8313
Practice Address - Fax:561-323-4999
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3175213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340615600Medicaid
FLU4287AMedicare PIN
FL340615600Medicaid
FL5183100002Medicare NSC