Provider Demographics
NPI:1891957965
Name:FARMINGTON HILLS INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:FARMINGTON HILLS INTERNAL MEDICINE PC
Other - Org Name:FARMINGTON HILLS INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-827-4322
Mailing Address - Street 1:26206 W 12 MILE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1754
Mailing Address - Country:US
Mailing Address - Phone:248-827-4322
Mailing Address - Fax:248-827-7822
Practice Address - Street 1:26206 W 12 MILE RD
Practice Address - Street 2:SUITE #200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1754
Practice Address - Country:US
Practice Address - Phone:248-827-4322
Practice Address - Fax:248-827-7822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARMINGTON HILLS INTERNAL MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-30
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0110634082OtherBCBSM PIN
MI0110930751OtherBCBSM NEW INDIVIDUAL
MI104099772Medicaid
MI1891957965OtherGROUP NPI
MI0F39878OtherBCBSM GROUP ID#
MI1801805270OtherINDIVIDUAL NPI
MIFO7601Medicare UPIN