Healthcare Provider Details

I. General information

NPI: 1710281647
Provider Name (Legal Business Name): CONSULTATIVE HEALTH AND MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 RIDGEWOOD CV
MINNETRISTA MN
55364-8239
US

IV. Provider business mailing address

5520 RIDGEWOOD CV
MINNETRISTA MN
55364-8239
US

V. Phone/Fax

Practice location:
  • Phone: 612-868-0136
  • Fax: 952-472-3837
Mailing address:
  • Phone: 612-868-0136
  • Fax: 952-472-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1547
License Number StateMN

VIII. Authorized Official

Name: DR. CHRIS JAMES JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 612-868-0136