MEDICARE: MICHAEL JOHNSON

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	347C00000X	Private Vehicle	RS728252	OH

General Provider Information

NPI Number	:	1356914733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOHNSON

Provider Business Mailing Address
First Line	:	2408 DEEWOOD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2255
Country	:	US
Telephone Number	:	614-394-4258
Fax Number	:

Provider Business Practice Location Address
First Line	:	2408 DEEWOOD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2255
Country	:	US
Telephone Number	:	614-394-4258
Fax Number	:

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

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	08/23/2021

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Directions to “ MICHAEL JOHNSON ” Practice Location

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