Healthcare Provider Details

I. General information

NPI: 1518907138
Provider Name (Legal Business Name): SHERYL L JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2514
US

IV. Provider business mailing address

PO BOX 30516 DEPT 9541
LANSING MI
48909-8016
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-2660
  • Fax:
Mailing address:
  • Phone: 800-475-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number35.131146
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101231150
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number4301502126
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: