Healthcare Provider Details

I. General information

NPI: 1497932750
Provider Name (Legal Business Name): JOHNSON PODIATRY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERTOWER PL STE 300
EAST LANSING MI
48823-8048
US

IV. Provider business mailing address

1500 WATERTOWER PL STE 300
EAST LANSING MI
48823-8049
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-7640
  • Fax: 517-351-9462
Mailing address:
  • Phone: 517-351-7640
  • Fax: 517-351-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number590100788
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001391
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5901001875
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN JOHNSON D
Title or Position: PHYSICIAN
Credential: DPM
Phone: 517-351-7640