Healthcare Provider Details

I. General information

NPI: 1932142809
Provider Name (Legal Business Name): TIFFANIE JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/07/2026
Certification Date: 02/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RILEY HOSPITAL DR. MSA 2
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

PO BOX 719094 PO BOX 719094
CHICAGO IL
60677-9318
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-8906
  • Fax: 317-274-4022
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number01054582
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number01054582
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01054582
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: