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
1	213ES0131X	Foot Surgery Podiatrist	939	MN

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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