MEDICARE: ANGELA 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	207R00000X	Internal Medicine Physician	01035146	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	:	1346257789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA JOHNSON MD

Provider Business Mailing Address
First Line	:	10330 N MERIDIAN ST #300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46209-1024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 PARKDALE PL
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5620
Country	:	US
Telephone Number	:	317-415-7373
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/06/2017

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