MEDICARE: DR. JEAN LEOPOLD EDWIN RENAUD 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
1	207Q00000X	Family Medicine Physician	226985	NY

General Provider Information

NPI Number	:	1235177668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN LEOPOLD EDWIN RENAUD MD

Provider Business Mailing Address
First Line	:	10540 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4604
Country	:	US
Telephone Number	:	718-241-1784
Fax Number	:	718-940-0907

Provider Business Practice Location Address
First Line	:	76 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3104
Country	:	US
Telephone Number	:	718-940-3000
Fax Number	:	718-940-0907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	03/28/2008

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