Provider Demographics
NPI:1760640064
Name:PAMELA D. JOHNSON, M.D., P.C.
Entity Type:Organization
Organization Name:PAMELA D. JOHNSON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-852-2040
Mailing Address - Street 1:245 BARCLAY CIR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5815
Mailing Address - Country:US
Mailing Address - Phone:248-852-2040
Mailing Address - Fax:248-853-7258
Practice Address - Street 1:245 BARCLAY CIR
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5815
Practice Address - Country:US
Practice Address - Phone:248-852-2040
Practice Address - Fax:248-853-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPJ048870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B8910OtherM-CARE
102263OtherPREFERRED CHOICES PPO
2422609003OtherCIGNA
4133392OtherAETNA
MI74717AOtherHEALTH ALLIANCE PLAN
MI0633185OtherBC/BS OF MI
MI0633185OtherBC/BS OF MI
MIE68216Medicare UPIN