MEDICARE: MELINDA E 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
1	207V00000X	Obstetrics & Gynecology Physician	4301070028	MI
2	174400000X	Specialist	MJ070028	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	:	1821088220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA E JOHNSON MD

Provider Business Mailing Address
First Line	:	5039 MOUNTAIN RIDGE DR NE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9557
Country	:	US
Telephone Number	:	616-581-3015
Fax Number	:

Provider Business Practice Location Address
First Line	:	5039 MOUNTAIN RIDGE DR NE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9557
Country	:	US
Telephone Number	:	616-581-3015
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/02/2024

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Directions to “ MELINDA E JOHNSON MD” Practice Location

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