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NPI Code Detail

MEDICARE: MICHELLE L JOHNSON MD

MEDICARE: MICHELLE L JOHNSON MD
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
1207Q00000XFamily Medicine Physician44734MN

Other Identifiers

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

General Provider Information

NPI Number : 1316933153
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE L JOHNSON MD
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 952-428-0200
Fax Number : 952-428-0499
Provider Business Practice Location Address
First Line : 6350 W 143RD ST STE 102
Second Line :
City : SAVAGE
State : MN
Zip : 55378-2890
Country : US
Telephone Number : 952-428-0200
Fax Number : 952-428-0499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 03/11/2021

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Directions to “ MICHELLE L JOHNSON MD” Practice Location

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