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General NPI Number Information
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NPI Number | 1215966528
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Entity Type | Individual
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Provider Name | HELENE M JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 42 N SAINT JOSEPH AVE SUITE 200
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City | NILES
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State | MI
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Zip | 49120-2203
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Country | US
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Telephone | 269-687-0808
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Fax | 269-687-0811
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Provider Business Mailing Address
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Address Line | 6416 DEANS HILL RD
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City | BERRIEN CENTER
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State | MI
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Zip | 49102-9750
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Country | US
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Telephone | 269-471-7741
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Fax | 269-471-1581
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301030791
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License Number State | MI
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