Individual
JEFFERSON LUSTRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
204 N INGALLS ST, ANN ARBOR, MI 48104-1568
(407) 402-4446
Mailing address
204 N INGALLS ST, ANN ARBOR, MI 48104-1568
(407) 402-4446
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/15/2025
Last updated
01/15/2025
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