Healthcare Provider Details

I. General information

NPI: 1851238059
Provider Name (Legal Business Name): ANDREW JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CLEVELAND ST
ELYRIA OH
44035-6141
US

IV. Provider business mailing address

153 ELMA DR
ELYRIA OH
44035-3909
US

V. Phone/Fax

Practice location:
  • Phone: 614-725-7313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number33.026347
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: