NPI 1164820171

Marion Justice

Practitioner Exclusive Provider Organization Detroit, MI

Practice location

Address: 3041 Bewick St, Detroit, MI 48214-2161
Phone: (313) 410-9028
Mailing address: PO Box 3359, Highland Park, MI 48203-0359

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1164820171
Entity type: Individual
Sex (as registered): Female
NPI issued: 8 Dec 2014
Record last updated: 12 Dec 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.