Individual
RONALDO SAN JUAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 KIRTS BLVD, TROY, MI 48084-4134
(248) 824-6299
(248) 479-0525
Mailing address
PO BOX 1239, TROY, MI 48099-1239
(248) 824-6600
(248) 324-1477
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
4301031888
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301031888
MI
208D00000X
General Practice Physician
4301031888
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010065414
RR MEDICARE
MI
05
—
4362240
—
MI
01
—
700F374320
BCBS OF MI GROUP #
MI
Enumeration date
09/12/2006
Last updated
08/28/2012
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