MRS. LISA MARIE RANDON (NPI# 1316088644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316088644 |
| Entity Type | Individual |
| Full Name | MRS. LISA MARIE RANDON |
| Other Name | MISS LISA MARIE HARRELL |
| Credential | M.D. |
| Practice Address |
2395 W Grand Blvd Detroit MI 48208-1210 |
| Mailing Address |
1511 Brooklyn St Detroit MI 48226-1007 |
| Practice Telephone | 3138312442 |
| Practice Fax Number | 3138312442 |
| Mailing Telephone | 3136081510 |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2017-02-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 4301068207 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
2395 W GRAND BLVD |
| City | DETROIT |
| State | MI |
| Zip Code | 48208-1210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992709331 | Professional Plaza Clinic Corporation | Legal Medicine | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2005-06-13 |
| 1184808966 | Ann Davis Garvin | Advanced Practice Midwife | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2007-12-28 |
| 1043369929 | David Alton Aprahamian | Family Medicine | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2007-01-09 |
| 1114097870 | Edna Ruth Jackson | Registered Nurse | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2006-11-09 |
| 1871695312 | Betty Ann Dornbrook | Nurse Practitioner | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2006-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616554 | Henry Ford Health System | Pharmacy | 2800 W Grand Blvd, Detroit, MI 48208 | 2020-10-16 |
| 1932645405 | Diane Louise Dodson | Counselor | 5500 Trumbull Apt 315, Detroit, MI 48208 | 2017-01-09 |
| 1164881306 | Cory Eugene Martin | Counselor | 1852 W. Grand Blvd., Detroit, MI 48208 | 2016-02-16 |
| 1578947784 | Hamza Belhaj | Dentist | 2700 Martin Luther King Jr Blvd, Detroit, MI 48208 | 2015-07-17 |
| 1942629167 | Diana Pool | Counselor | 3737 Lawton, Detroit, MI 48208 | 2014-04-15 |
| 1124467048 | Aisha Williams | Social Worker | 4707 Vinewood St., Detroit, MI 48208 | 2013-06-25 |
| 1295079895 | Mia Love | Nurse Practitioner | 2959 Martin Luther King Jr Blvd, Detroit, MI 48208 | 2012-11-20 |
| 1992064356 | Valarie Egeria Foulks | Counselor | 2051 W. Grand Blvd, Detroit, MI 48208 | 2012-05-04 |
| 1023304078 | Ayana Njeri Davis | Massage Therapist | 2550 W. Grand Blvd, Detroit, MI 48208 | 2011-06-28 |
| 1184922627 | Shar Inc. | Community Based Residential Treatment Facility, Mental Illness | 1852 W.grand Blvd, Detroit, MI 48208 | 2011-03-08 |
| Find all providers in zip 48208 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730708058 | Xuexin Lu | Pediatrics | 22101 Moross Rd Ste 80, Detroit, MI 48236-2148 | 2020-04-16 |
| 1235636408 | Healthy Kids Plc | Pediatrics | 18060 Conant St, Detroit, MI 48234-1628 | 2018-04-12 |
| 1841720539 | Krystal Yee-yun Chan-zlatopolsky | Pediatrics | 22201 Moross Rd Ste 80, Detroit, MI 48236-2166 | 2017-06-14 |
| 1508220062 | Marlisa Rose Wolf | Pediatrics | Children's Hospital of Mi - 3rd Fl, 3901 Beaubien, Detroit, MI 48201 | 2016-04-11 |
| 1821418419 | Christina Louise Santia | Pediatrics | Children's Hospital of Mi/ Spec Ctr, 3950 Beaubien Garden Level, Detroit, MI 48201 | 2014-04-22 |
| 1033537089 | Kimberly Lynn Herrmann | Pediatrics | Children's Hospital of Mi / Spec Ctr, 3950 Beaubien, Detroit, MI 48201 | 2014-04-06 |
| 1932540622 | Ramya Deepthi Billa | Pediatrics | 3901 Beaubien - 3rd Fl, Children's Hospital of Mi, Detroit, MI 48201 | 2013-07-10 |
| 1942646658 | Silpa Nadella | Pediatrics | 3950 Beaubien St Fl 4, Detroit, MI 48201-2166 | 2013-05-21 |
| 1770826984 | Lonetta L Postell | Pediatrics | 3031 W. Grand Blvd, 800, Detroit, MI 48202-2119 | 2013-04-05 |
| 1578806964 | Scott C Grant | Pediatrics | Chm/specialty Center, 3950 Beaubien 1st Fl, Detroit, MI 48201 | 2013-04-03 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.