=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306058680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL P JOHNSON DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1480 W CENTER RD
-----------------------------------------------------
City | ESSEXVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48732-2143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-895-4625
-----------------------------------------------------
Fax | 989-895-4626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 S BALLENGER HWY
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-342-1000
-----------------------------------------------------
Fax | 810-342-1590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5101016875
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------