Provider Demographics
NPI:1689863870
Name:HAROLD JOH, MD.PC
Entity Type:Organization
Organization Name:HAROLD JOH, MD.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-729-3133
Mailing Address - Street 1:1547 S WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5436
Mailing Address - Country:US
Mailing Address - Phone:734-729-3133
Mailing Address - Fax:734-729-3130
Practice Address - Street 1:1547 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5436
Practice Address - Country:US
Practice Address - Phone:734-729-3133
Practice Address - Fax:734-729-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P20190Medicare PIN