MEDICARE: DR. MICHAEL D JOHN 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
1	207N00000X	Dermatology Physician	15126	OK

General Provider Information

NPI Number	:	1790788586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D JOHN MD

Provider Business Mailing Address
First Line	:	620 W 15TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3617
Country	:	US
Telephone Number	:	405-359-0551
Fax Number	:	405-359-3061

Provider Business Practice Location Address
First Line	:	620 W 15TH ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3617
Country	:	US
Telephone Number	:	405-359-0551
Fax Number	:	405-359-3061

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/25/2025

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