MEDICARE: DR. DAVID K 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	2088P0231X	Pediatric Urology Physician	DJ036689	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	340009577	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	DR330319	OTHER	MCARE
4	1000638	OTHER	MCLAREN
5	200000002171	OTHER	PHYSICIAN HEALTH PLAN
6	340C376010	OTHER	BLUE CROSS BLUE SHIELD
7	4496865	OTHER	AETNA

General Provider Information

NPI Number	:	1982799011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID K JOHNSON M.D.

Provider Business Mailing Address
First Line	:	2175 COOLIDGE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-1379
Country	:	US
Telephone Number	:	517-324-3705
Fax Number	:	517-324-4589

Provider Business Practice Location Address
First Line	:	1625 RAMBLEWOOD DR
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6367
Country	:	US
Telephone Number	:	517-324-3705
Fax Number	:	517-324-4589

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/14/2014

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Directions to “ DR. DAVID K JOHNSON M.D.” Practice Location

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