MEDICARE: JOHNSON J THOTTAM MD INC.

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	261QM2500X	Medical Specialty Clinic/Center	037564	OH

General Provider Information

NPI Number	:	1144594813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON J THOTTAM MD INC.

Provider Business Mailing Address
First Line	:	4800 HIGBEE AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2528
Country	:	US
Telephone Number	:	330-492-8521
Fax Number	:	330-492-1967

Provider Business Practice Location Address
First Line	:	4800 HIGBEE AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2528
Country	:	US
Telephone Number	:	330-492-8521
Fax Number	:	330-492-1967

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHNSON JOHN THOTTAM
Credential	:	M.D
Telephone Number	:	330-492-8521

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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