Lisa M Randon MD LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301068207 Issued in MI

Legal business name

LISA M RANDON MD LLC

Practice address

3990 John R St
Detroit, MI 48201-2018

Phone

(313) 745-5111

NPI assigned

Jun 21, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Marie Randon, MD

Title

Physician

Phone

(313) 608-1510

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1699295659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 W FORT ST UNIT 442450",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482443599",
            "telephone_number": "313-608-1510",
            "fax_number": "313-656-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012018",
            "telephone_number": "313-745-5111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6071 W Outer Dr",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482352624",
            "country_code": "US",
            "telephone_number": "313-745-5111 x6091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LISA M RANDON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "RANDON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "313-608-1510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301068207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Lipsman, PA-C
• Egbert Joseph Cadena Liquete, M.D.
• Antonio Lira Diaz, MD
• Meghan Gaffney Liroff, M.D.
• Damian W Lis
• Robert Philip Lisak, MD
• Jenaye Laron Lisbon, FNP
• Michelle Marie Liss Gaits
• Ryan Walter Lithgow, PHYSICAL THERAPIST
• Melody Stashia Litkouhi, LMSW

• Pediatrics Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.