Provider Demographics
NPI:1346750098
Name:KLOP, RANDI SHEL (RDN)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:SHEL
Last Name:KLOP
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:RANDI
Other - Middle Name:SHEL
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7901 S 12TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3831
Mailing Address - Country:US
Mailing Address - Phone:269-341-8317
Mailing Address - Fax:
Practice Address - Street 1:7901 S 12TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3831
Practice Address - Country:US
Practice Address - Phone:269-341-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered