Organization
LISA M RANDON MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA MARIE RANDON MD (PHYSICIAN)
(313) 608-1510
Entity
Organization
Contact information
Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-5111
Mailing address
1401 W FORT ST UNIT 442450, DETROIT, MI 48244-3599
(313) 608-1510
(313) 656-4056
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301068207
MI
Other
Enumeration date
06/21/2017
Last updated
03/17/2018
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