Active NPI
Michael Christopher Randolph
- Behavior Technician
- Lake Bluff, IL
National Provider Identifier
1922752153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 917 Sherwood Dr Ste 201
Lake Bluff, IL 60044-2235 - Phone
- (855) 318-6404
- NPI assigned
- Feb 7, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | IL | Primary |
Addresses
Primary practice location
917 Sherwood Dr Ste 201
Lake Bluff, IL 60044-2235
Mailing address
950 Lee St Ste 210
Des Plaines, IL 60016-6574
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644192000000",
"number": "1922752153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 LEE ST STE 210",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600166574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 SHERWOOD DR STE 201",
"city": "LAKE BLUFF",
"state": "IL",
"postal_code": "600442235",
"telephone_number": "855-318-6404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "MICHAEL",
"middle_name": "CHRISTOPHER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-07",
"last_updated": "2022-02-07",
"certification_date": "2022-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Bluff, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.