Healthcare Provider Details

I. General information

NPI: 1639277452
Provider Name (Legal Business Name): STEVEN PAUL JOHNSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

IV. Provider business mailing address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-2370
  • Fax: 616-527-3824
Mailing address:
  • Phone: 616-527-2370
  • Fax: 616-527-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSJ008296
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101008296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: