Provider Demographics
NPI:1609333863
Name:DRAIN, JUSTIN ROBERT
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:DRAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13350 BUNKERHILL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49272-9640
Mailing Address - Country:US
Mailing Address - Phone:517-262-2473
Mailing Address - Fax:
Practice Address - Street 1:13350 BUNKERHILL RD
Practice Address - Street 2:
Practice Address - City:PLEASANT LAKE
Practice Address - State:MI
Practice Address - Zip Code:49272-9640
Practice Address - Country:US
Practice Address - Phone:517-262-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program