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General NPI Number Information
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NPI Number | 1346773512
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Entity Type | Individual
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Provider Name | COLIN JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 3232 N BALLARD RD STE 100
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City | APPLETON
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State | WI
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Zip | 54911-8804
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Country | US
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Telephone | 920-729-7105
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Fax | 920-739-2609
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Provider Business Mailing Address
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Address Line | 3232 N BALLARD RD STE 100
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City | APPLETON
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State | WI
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Zip | 54911-8804
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Country | US
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Telephone | 920-729-7105
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Fax | 920-831-8306
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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 | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | MD-49494
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 70977
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 70977
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License Number State | WI
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