Individual
JUSTIN SEVERANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2799 W GRAND BLVRD, DETROIT, MI 48202-4820
(313) 916-2695
Mailing address
1026 NP AVE N, UNIT 110, FARGO, ND 58102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-99519
MT
Other
Enumeration date
09/01/2016
Last updated
12/14/2021
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