MEDICARE: DR. COLLEEN NICOLE JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	432581	KS
2	207Y00000X	Otolaryngology Physician	2014028851	MO

General Provider Information

NPI Number	:	1033301510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN NICOLE JOHNSON M.D.

Provider Business Mailing Address
First Line	:	5101 COLLEGE BLVD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1614
Country	:	US
Telephone Number	:	816-478-4200
Fax Number	:	816-875-2598

Provider Business Practice Location Address
First Line	:	2300 HUTTON RD STE 106107
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4436
Country	:	US
Telephone Number	:	913-721-3387
Fax Number	:	816-875-2598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	07/25/2024

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