Randall Scott Highbaugh Jr., ATC
Individual provider Active NPI Sports Medicine (Emergency Medicine) Physician · Channahon, IL
NPI 1942089883 · NPPES record last updated Sep 28, 2023
Key facts
- NPI
- 1942089883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Emergency Medicine) Physician 207PS0010X
- License
- 096003299 (IL)
- Practice address
- 26636 W Ian CT
Channahon, IL 60410-5505 - Phone
- (815) 347-4522
- NPI assigned
- Sep 28, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096003299 | IL | MD | Sports Medicine (Emergency Medicine) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | 096003299 | IL | Yes |
Addresses
Primary practice location
26636 W Ian CT
Channahon, IL 60410-5505
Mailing address
26636 W Ian CT
Channahon, IL 60410-5505
Phone (815) 347-4522
Other providers in Channahon, IL
- Gustavo a . Pedraza M.D., LTD
- Gustavo a. Pedraza, M.D., LTD.
- Rachel Marie Hamilton
- Stefanie Henline
- Rachel Herzberger
- Lisa Ann Hill
- Trisha Larena Holder
- Madelynn Jane Hugunin
- Illinois Oral Surgery & Implant Center of Channahon
- Sheryl M Janz
All providers in Channahon, IL · Sports Medicine (Emergency Medicine) Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.