Healthcare Provider Details

I. General information

NPI: 1821101346
Provider Name (Legal Business Name): BARBARA A JOHNSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4737 COUNTY ROAD 101 SUITE 124
MINNETONKA MN
55345
US

IV. Provider business mailing address

4737 COUNTY ROAD 101 SUITE 124
MINNETONKA MN
55345
US

V. Phone/Fax

Practice location:
  • Phone: 612-710-3671
  • Fax: 763-295-4946
Mailing address:
  • Phone: 612-710-3671
  • Fax: 763-295-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELE BATKIEWICZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-710-3671