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NPI Code Detail

MEDICARE: DR. MELANIE JOHNSON D.P.M.

MEDICARE:  DR. MELANIE  JOHNSON  D.P.M.
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
1213ES0131XFoot Surgery Podiatrist939MN

General Provider Information

NPI Number : 1053639732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELANIE JOHNSON D.P.M.
Provider Business Mailing Address
First Line : 4653 WHITE BEAR PKWY
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-3300
Country : US
Telephone Number : 651-426-3995
Fax Number : 651-426-5626
Provider Business Practice Location Address
First Line : 4653 WHITE BEAR PKWY
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110
Country : US
Telephone Number : 651-426-3995
Fax Number : 651-426-5626
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2010
Last Update Date : 10/23/2018

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Directions to “ DR. MELANIE JOHNSON D.P.M.” Practice Location

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