MEDICARE: DR. CHRISTOPHER MILES JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0203X	Pediatric Critical Care Medicine Physician	38356	CO
2	2080P0203X	Pediatric Critical Care Medicine Physician	01062005A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023077740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER MILES JOHNSON M.D.

Provider Business Mailing Address
First Line	:	1850 BANDELIER COURT
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-1613
Country	:	US
Telephone Number	:	505-795-3208
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 BANDELIER COURT
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-1613
Country	:	US
Telephone Number	:	505-795-3208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	04/03/2023

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