MEDICARE: DR. MICHEAL B. JOHNSON D.O.

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	2085R0202X	Diagnostic Radiology Physician	C2-0006432	DE
2	2085R0202X	Diagnostic Radiology Physician	20A9408	CA
3	2085R0202X	Diagnostic Radiology Physician	O-0402	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205820842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHEAL B. JOHNSON D.O.

Provider Business Mailing Address
First Line	:	3650 PIPER STREET, STE A
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508
Country	:	US
Telephone Number	:	907-339-9455
Fax Number	:	907-339-9445

Provider Business Practice Location Address
First Line	:	7171 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2665
Country	:	US
Telephone Number	:	317-614-9804
Fax Number	:

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	12/28/2022

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