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General NPI Number Information
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NPI Number | 1265517155
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Entity Type | Individual
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Provider Name | RANDALL M JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 184 US HIGHWAY 41 E
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City | NEGAUNEE
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State | MI
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Zip | 49866-9606
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Country | US
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Telephone | 906-315-2607
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Fax | 906-475-9312
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Provider Business Mailing Address
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Address Line | 184 US HIGHWAY 41 E
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City | NEGAUNEE
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State | MI
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Zip | 49866-9606
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Country | US
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Telephone | 906-315-2607
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Fax | 906-475-9312
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | RJ040842
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License Number State | MI
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