Provider Demographics
NPI:1437128253
Name:SAN JUAN, MARIA BELEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA BELEN
Middle Name:R
Last Name:SAN JUAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:205 W GRAND RIVER AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1659
Mailing Address - Country:US
Mailing Address - Phone:734-995-0303
Mailing Address - Fax:734-995-0425
Practice Address - Street 1:4200 WHITEHALL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9694
Practice Address - Country:US
Practice Address - Phone:734-995-0303
Practice Address - Fax:734-995-0425
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2019-12-23
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Provider Licenses
StateLicense IDTaxonomies
MIMS057576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81490Medicare UPIN