Randy John Plonka, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

050787 Issued in MI

Practice address

5979 Lakeshore
Ft Gratiot, MI 48059

Phone

(810) 385-6370

Fax

(810) 385-6357

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205884800000",
    "number": "1013097278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5979 LAKESHORE",
            "city": "FT GRATIOT",
            "state": "MI",
            "postal_code": "48059",
            "telephone_number": "810-385-6370",
            "fax_number": "810-385-6357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5979 LAKESHORE",
            "city": "FT GRATIOT",
            "state": "MI",
            "postal_code": "48059",
            "telephone_number": "810-385-6370",
            "fax_number": "810-385-6357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLONKA",
        "first_name": "RANDY",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2008-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "050787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4369770",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Ft Gratiot, MI
• Providers in Ft Gratiot, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.