MEDICARE: MR. JAMES EDWARD JOHNSON D.O.

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	208600000X	Surgery Physician	007081	MI

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	:	1467450304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES EDWARD JOHNSON D.O.

Provider Business Mailing Address
First Line	:	37400 GARFIELD RD
Second Line	:	SUITE 120
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3648
Country	:	US
Telephone Number	:	586-228-3800
Fax Number	:	586-228-9800

Provider Business Practice Location Address
First Line	:	37400 GARFIELD RD
Second Line	:	SUITE 120
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3648
Country	:	US
Telephone Number	:	586-228-3800
Fax Number	:	586-228-9800

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/09/2007

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