| Doctor Name: | RONALDO SAN JUAN |
| NPI Number: | 1629172317 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 4301031888 |
| Business Practice Address: | 500 Kirts Blvd Troy, MI - 480844134 |
| Business Phone Number: | 2488246299 |
| Business Fax Number: | 2484790525 |
| Mailing Address: | Po Box 1239, TROY |
| State: | MI |
| Postal Code: | 480991239 |
| Phone Number: | 2488246600 |
| Fax Number: | 2483241477 |
| NPI Enumeration Date: | 09/12/2006 |
| NPI Last Update Date: | 08/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301031888 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |