Provider Demographics
NPI:1720566466
Name:JURIDICO, RENE SIAZON (DPM)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:SIAZON
Last Name:JURIDICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 WATERTOWER PL STE 300
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8049
Mailing Address - Country:US
Mailing Address - Phone:517-351-7640
Mailing Address - Fax:
Practice Address - Street 1:1600 S KALAMAZOO AVE STE A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-8730
Practice Address - Country:US
Practice Address - Phone:269-781-4700
Practice Address - Fax:269-781-7168
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901400406213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery