Individual
RODOLFO LEONGSON SAN JUAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11161 RANDOLPH ST, CROWN POINT, IN 46307-8564
(219) 662-9424
(219) 662-7465
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01064429A
IN
207Q00000X
Family Medicine Physician
0116017383
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200386920
—
IN
Enumeration date
05/31/2007
Last updated
09/14/2023
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