Provider Demographics
NPI:1538201397
Name:J. DRAGUN, P.C.
Entity type:Organization
Organization Name:J. DRAGUN, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:810-227-6218
Mailing Address - Street 1:5841 WHITMORE LAKE RD
Mailing Address - Street 2:STE A
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2470
Mailing Address - Country:US
Mailing Address - Phone:810-227-6218
Mailing Address - Fax:844-965-9618
Practice Address - Street 1:5841 WHITMORE LAKE RD
Practice Address - Street 2:STE A
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2470
Practice Address - Country:US
Practice Address - Phone:810-227-6218
Practice Address - Fax:844-965-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009392103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty