MEDICARE: CHERYL K JOHNSON M.D.

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	207Q00000X	Family Medicine Physician	24979	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251280	OTHER	IA	WELLMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467504597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL K JOHNSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 260
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-0260
Country	:	US
Telephone Number	:	319-626-6006
Fax Number	:	319-626-3400

Provider Business Practice Location Address
First Line	:	585 W CHERRY ST
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-9797
Country	:	US
Telephone Number	:	319-626-6006
Fax Number	:	319-626-3400

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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