Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301111018 | MI |
NPI | 1093260929 |
---|---|
Provider Name | Dr. Justine Pearl |
First Address | Flint, MI 48507-2677 |
Second Address | Flint, MI 48507-2677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2016 |
Last Update Date | 23/01/2017 |