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NPI Code Detail

MEDICARE: RONALDO SAN JUAN MD

MEDICARE: RONALDO SAN JUAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician4301031888MI
2208D00000XGeneral Practice Physician4301031888MI
3207RI0011XInterventional Cardiology Physician4301031888MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2010065414OTHERMIRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3700F374320OTHERMIBCBS OF MI GROUP #

General Provider Information

NPI Number : 1629172317
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALDO SAN JUAN MD
Provider Business Mailing Address
First Line : PO BOX 1239
Second Line :
City : TROY
State : MI
Zip : 48099-1239
Country : US
Telephone Number : 248-824-6600
Fax Number : 248-324-1477
Provider Business Practice Location Address
First Line : 500 KIRTS BLVD
Second Line :
City : TROY
State : MI
Zip : 48084-4134
Country : US
Telephone Number : 248-824-6299
Fax Number : 248-479-0525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2006
Last Update Date : 08/28/2012

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Directions to “ RONALDO SAN JUAN MD” Practice Location

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