MEDICARE: JOHNSON MEDICAL GROUP PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician	K2046	TX

General Provider Information

NPI Number	:	1710261771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	1012 CAMPBELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7408
Country	:	US
Telephone Number	:	713-468-3155
Fax Number	:	281-809-7001

Provider Business Practice Location Address
First Line	:	1012 CAMPBELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7408
Country	:	US
Telephone Number	:	281-978-2502
Fax Number	:	832-358-2226

Authorized Official
Title or Position	:	OWNER AND PROVIDER
Name	:	DR. CHERYL K JOHNSON
Credential	:	MD
Telephone Number	:	713-468-3155

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	02/26/2016

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