=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891957965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMINGTON HILLS INTERNAL MEDICINE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2008
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29877 TELEGRAPH RD STE 300
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-7660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-827-4322
-----------------------------------------------------
Fax | 248-827-7822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29877 TELEGRAPH RD STE 300
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48034-7660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-827-4322
-----------------------------------------------------
Fax | 248-827-7822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AMOS CHARLES JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 248-827-4322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------