Healthcare Provider Details

I. General information

NPI: 1043299555
Provider Name (Legal Business Name): CRAIG H JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SMITH AVE N STE 700
SAINT PAUL MN
55102-2972
US

IV. Provider business mailing address

310 SMITH AVE N STE 303
SAINT PAUL MN
55102-2393
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-3535
  • Fax:
Mailing address:
  • Phone: 651-241-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number60797-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number30848
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: