Individual
DEYANKA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2925 RUSSELL ST, DETROIT, MI 48239-1093
(313) 396-5300
Mailing address
7557 LAMPHERE, DETROIT, MI 48239-1093
(313) 718-4175
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
00000000000000000000
MI
Other
Enumeration date
11/06/2014
Last updated
11/06/2014
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