Healthcare Provider Details

I. General information

NPI: 1598724767
Provider Name (Legal Business Name): STEVEN M JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 RIDGEWOOD CT.
CONNERSVILLE IN
47331-1264
US

IV. Provider business mailing address

908 RIDGEWOOD CT.
CONNERSVILLE IN
47331-1264
US

V. Phone/Fax

Practice location:
  • Phone: 765-265-5756
  • Fax:
Mailing address:
  • Phone: 765-265-5756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02002166A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO-03490
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2015015367
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number46941-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: