Healthcare Provider Details

I. General information

NPI: 1922088624
Provider Name (Legal Business Name): MICHAEL M JOH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36175 HARPER AVE
CLINTON TOWNSHIP MI
48035-3274
US

IV. Provider business mailing address

36175 HARPER AVE
CLINTON TOWNSHIP MI
48035-3274
US

V. Phone/Fax

Practice location:
  • Phone: 586-741-3772
  • Fax: 586-741-4604
Mailing address:
  • Phone: 586-741-3772
  • Fax: 586-741-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number4301031473
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: