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General NPI Number Information
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NPI Number | 1902955560
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Entity Type | Organization
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Legal Business Name | CHARLES M JOHNSON PODIATRIST PC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 10244 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48221-1904
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Country | US
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Telephone | 313-862-5800
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Fax | 313-862-2865
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Provider Business Mailing Address
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Address Line | 10244 W 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48221-1904
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Country | US
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Telephone | 313-862-5800
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Fax | 313-862-2865
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. CHARLES M. JOHNSON
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Credential | DPM
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Telephone | 313-862-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | CJ001211
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License Number State | MI
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