Healthcare Provider Details

I. General information

NPI: 1215966528
Provider Name (Legal Business Name): HELENE M JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N SAINT JOSEPH AVE SUITE 200
NILES MI
49120-2203
US

IV. Provider business mailing address

6416 DEANS HILL RD
BERRIEN CENTER MI
49102-9750
US

V. Phone/Fax

Practice location:
  • Phone: 269-687-0808
  • Fax: 269-687-0811
Mailing address:
  • Phone: 269-471-7741
  • Fax: 269-471-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301030791
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: