Individual
JUSTIN PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
24725 W 12 MILE RD STE 260, SOUTHFIELD, MI 48034-8310
(248) 382-8052
Mailing address
2701 PARK AVE, DETROIT, MI 48201-3041
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011860
MI
Other
Enumeration date
07/05/2023
Last updated
10/18/2023
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