MEDICARE: STEPHEN M JOHNSON MD PC

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	207W00000X	Ophthalmology Physician	01027083	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	:	1528266517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN M JOHNSON MD PC

Provider Business Mailing Address
First Line	:	200 W 103RD ST
Second Line	:	STE 1000
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1092
Country	:	US
Telephone Number	:	317-817-1765
Fax Number	:	317-817-1767

Provider Business Practice Location Address
First Line	:	200 W 103RD ST
Second Line	:	STE 1000
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1092
Country	:	US
Telephone Number	:	317-817-1765
Fax Number	:	317-817-1767

Authorized Official
Title or Position	:	OFFICE COORDINATOR
Name	:	MRS. LISA CHATLOS
Credential	:
Telephone Number	:	317-817-1762

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	12/18/2012

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