MEDICARE: TODD M JOHNSON MD

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	2085R0202X	Diagnostic Radiology Physician	01055574A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	959090188	OTHER	IN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	Q00523653	OTHER	IN	RAILROAD PTAN

General Provider Information

NPI Number	:	1275518979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD M JOHNSON MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13000 E 136TH ST
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-9478
Country	:	US
Telephone Number	:	317-678-1700
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	05/21/2024

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Directions to “ TODD M JOHNSON MD” Practice Location

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