2102 Randolph Vandalia Professional, Llc
Specialty details in registry · Vandalia, IL
At a glance
2102 W Randolph St, Vandalia, IL 62471-1973
NPPES record updated Oct 29, 2025. Public records can lag behind changes at a practice.
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Practice location
2102 W Randolph StVandalia, IL 62471-1973
Professional details: NPI, taxonomy & registry record
Registry details
- Primary taxonomy
- Specialty details in registry
- Taxonomy code
- 1223G0001X
- Enumeration date
- Oct 29, 2025
- Record updated
- Oct 29, 2025
More registry details
- Provider type
- Organization · Type 2
Reported taxonomies and licenses
Specialty details in registry
1223G0001X · Primary
License numbers and credentials are reported to NPPES; HCPList does not independently verify them.
Practice location
2102 W Randolph StVandalia, IL 62471-1973
- Phone
- (618) 283-4900
Mailing address
2102 W RANDOLPH STVANDALIA, IL 624711973
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