Individual
JUSTIN S KROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1902 13TH ST, PORT HURON, MI 48060-6238
(810) 300-8536
Mailing address
1902 13TH ST, PORT HURON, MI 48060-6238
(810) 300-8536
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
1863
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000
DO NOT HAVE
—
05
—
1863
—
CT
Enumeration date
11/04/2019
Last updated
12/10/2020
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