Provider Demographics
NPI:1235323676
Name:JUSTIN J MARONE PC
Entity Type:Organization
Organization Name:JUSTIN J MARONE PC
Other - Org Name:JUSTINE J MARONE DO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARONE
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:989-725-8436
Mailing Address - Street 1:1457 N M 52
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1234
Mailing Address - Country:US
Mailing Address - Phone:989-725-8436
Mailing Address - Fax:
Practice Address - Street 1:1457 N M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1234
Practice Address - Country:US
Practice Address - Phone:989-725-8436
Practice Address - Fax:989-723-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4282097Medicaid
E32902Medicare UPIN
MI4282097Medicaid