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NPI Code Detail

MEDICARE: JILL B JOHNSON MD

MEDICARE: JILL B 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
1207WX0107XRetina Specialist (Ophthalmology) Physician35138MN
2207W00000XOphthalmology Physician35138MN

Other Identifiers

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

General Provider Information

NPI Number : 1538157607
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL B JOHNSON MD
Provider Business Mailing Address
First Line : 3601 W 76TH ST
Second Line : STE 300
City : EDINA
State : MN
Zip : 55435-3004
Country : US
Telephone Number : 952-897-1175
Fax Number : 952-897-1178
Provider Business Practice Location Address
First Line : 7760 FRANCE AVE S
Second Line : SUITE 310
City : MINNEAPOLIS
State : MN
Zip : 55435-5800
Country : US
Telephone Number : 952-897-1175
Fax Number : 952-897-1178
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 08/20/2020

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Directions to “ JILL B JOHNSON MD” Practice Location

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