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General NPI Number Information
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NPI Number | 1649281361
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Entity Type | Individual
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Provider Name | ANDREW J JOHNSON DPM
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 1245 S WASHINGTON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3905
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Country | US
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Telephone | 218-846-2000
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Fax | 218-846-2114
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Provider Business Mailing Address
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Address Line | 1245 S WASHINGTON AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3905
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Country | US
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Telephone | 218-846-2000
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Fax | 218-846-2114
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 801
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO00000770
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 801
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License Number State | MN
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