Healthcare Provider Details

I. General information

NPI: 1346262821
Provider Name (Legal Business Name): JO ANN JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 W SILVER LAKE RD
FENTON MI
48430-1374
US

IV. Provider business mailing address

3220 W SILVER LAKE RD
FENTON MI
48430-1374
US

V. Phone/Fax

Practice location:
  • Phone: 810-750-1763
  • Fax: 810-750-1786
Mailing address:
  • Phone: 810-750-1763
  • Fax: 810-750-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101010026
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number5101010026
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: