Individual
REBA E. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5701 BOW POINTE DRIVE, SUITE 110, CLARKSTON, MI 48346-3199
(248) 384-8310
(248) 384-8312
Mailing address
5701 BOW POINTE DRIVE, SUITE 110, CLARKSTON, MI 48346-3199
(248) 384-8310
(248) 384-8312
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
4301082354
MI
207R00000X
Internal Medicine Physician
4301082354
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108205911
BCBS IND PIN
MI
05
—
1437178795
—
MI
05
—
488422710
—
MI
01
—
700H262220
BLUE CROSS-BLUE CROSS
—
01
—
RJ082354
CHAMPUS-CHAMPUS
—
Enumeration date
07/18/2006
Last updated
08/01/2017
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