Provider Demographics
NPI:1699708271
Name:LIPSCHER, RANDOLPH B (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:B
Last Name:LIPSCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-655-2553
Mailing Address - Fax:309-655-2602
Practice Address - Street 1:1110 W WILLIAM CANNON DR STE 404
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5498
Practice Address - Country:US
Practice Address - Phone:512-377-9904
Practice Address - Fax:512-717-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN67740207P00000X
VA0101278138207P00000X
TXJ9904207P00000X, 2083B0002X
MN62091207P00000X
KY43172207P00000X
IAMD50106207P00000X
IL036146670207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127548947Medicaid
KYP01209908OtherRAILROAD MEDICARE
TX8C1236OtherBCBS
KYK082340Medicare PIN
TX127548926Medicaid
TXG44401Medicare UPIN