Healthcare Provider Details

I. General information

NPI: 1053390849
Provider Name (Legal Business Name): STEVEN D JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 CHURCHILL ST W
STILLWATER MN
55082-6605
US

IV. Provider business mailing address

9975 DELLWOOD RD N
STILLWATER MN
55082-9425
US

V. Phone/Fax

Practice location:
  • Phone: 651-430-4617
  • Fax: 651-292-2178
Mailing address:
  • Phone: 651-429-7026
  • Fax: 651-292-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number8428
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47413
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28524
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: