Healthcare Provider Details

I. General information

NPI: 1114906963
Provider Name (Legal Business Name): KAREN ANN JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 160TH AVE SUITE 250
MIRAMAR FL
33027-6308
US

IV. Provider business mailing address

12201 PECOS ST
WESTMINSTER CO
80234-3888
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-4645
  • Fax: 855-855-2792
Mailing address:
  • Phone: 303-457-4497
  • Fax: 303-254-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30212
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: