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General NPI Number Information
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NPI Number | 1417083189
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Entity Type | Individual
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Provider Name | PAMELA D JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 4100 JOHN R ST KARMANOS CANCER CENTER
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City | DETROIT
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State | MI
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Zip | 48201-2013
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Country | US
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Telephone | 800-527-6266
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Fax | 313-576-8699
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Provider Business Mailing Address
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Address Line | 1420 STEPHENSON HWY SUITE 400-CREDENTIALING
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City | TROY
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State | MI
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Zip | 48083-1189
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Country | US
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Telephone | 248-581-5974
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Fax | 248-581-5640
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301048870
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License Number State | MI
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