Renato Siazon Lee, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301055115 Issued in MI

Practice address

611 W Belle Ave
Saint Charles, MI 48655-1611

Phone

(989) 865-9958

Fax

(989) 865-8099

NPI assigned

May 12, 2006

Last updated

Sep 29, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254182400000",
    "number": "1114977725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W BELLE AVE",
            "address_2": "PO BOX 160",
            "city": "SAINT CHARLES",
            "state": "MI",
            "postal_code": "486551611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W BELLE AVE",
            "city": "SAINT CHARLES",
            "state": "MI",
            "postal_code": "486551611",
            "telephone_number": "989-865-9958",
            "fax_number": "989-865-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "RENATO",
        "middle_name": "SIAZON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2009-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301055115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS OF MICHIGAN ID",
            "identifier": "080G360680",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN ID",
            "identifier": "0807341122",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4348831",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Girard, LMSW
• Ronald Gonzales Jr., M.D.
• Sadina L Gonzales, MSOT
• Jessica D Knight
• Michelle Lafrance
• Sarah Jean Leiner
• Julie Ann Martin, NP
• Meagen Mateialona, BS, MS, DC
• Hailey McGregor
• Real Mental Health Therapy

• Family Medicine Physician in Saint Charles, MI
• Providers in Saint Charles, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.