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General NPI Number Information
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NPI Number | 1760640064
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Entity Type | Organization
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Legal Business Name | PAMELA D. JOHNSON, M.D., P.C.
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 245 BARCLAY CIR SUITE 400
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5815
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Country | US
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Telephone | 248-852-2040
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Fax | 248-853-7258
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Provider Business Mailing Address
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Address Line | 245 BARCLAY CIR SUITE 400
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5815
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Country | US
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Telephone | 248-852-2040
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Fax | 248-853-7258
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Authorized Official
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Title or Position | C E O
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Name | MRS. PAMELA D JOHNSON
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Credential | M.D.
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Telephone | 248-852-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PJ048870
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License Number State | MI
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