Provider Demographics
NPI:1093260929
Name:PEARL, JUSTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:
Last Name:PEARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1221 SIXTH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2360
Mailing Address - Country:US
Mailing Address - Phone:231-392-0640
Mailing Address - Fax:231-392-0643
Practice Address - Street 1:1221 SIXTH ST STE 300
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2360
Practice Address - Country:US
Practice Address - Phone:231-392-0640
Practice Address - Fax:231-392-0643
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301111018207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery