Healthcare Provider Details

I. General information

NPI: 1689863870
Provider Name (Legal Business Name): HAROLD JOH, MD.PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 S WAYNE RD
WESTLAND MI
48186-5436
US

IV. Provider business mailing address

1547 S WAYNE RD
WESTLAND MI
48186-5436
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-3133
  • Fax: 734-729-3130
Mailing address:
  • Phone: 734-729-3133
  • Fax: 734-729-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: HAROLD JOH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-729-3133