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General NPI Number Information
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NPI Number | 1073975132
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Entity Type | Individual
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Provider Name | WILLIAM BECK JOHANSEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2016
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 6200 DUTCHMANS LN
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City | LOUISVILLE
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State | KY
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Zip | 40205-3271
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Country | US
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Telephone | 502-456-6200
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Fax | 502-456-6655
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Provider Business Mailing Address
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Address Line | 6200 DUTCHMANS LN
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City | LOUISVILLE
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State | KY
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Zip | 40205-3271
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Country | US
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Telephone | 502-456-6200
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Fax | 24-566-6555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 60650
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | 60650
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License Number State | KY
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