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1841282456

NPI Code Detail

MEDICARE: DR. EWANAH D JOHNSON MD

MEDICARE: DR. EWANAH D 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	207R00000X	Internal Medicine Physician	35078873J	OH
2	207R00000X	Internal Medicine Physician	4301091013	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1538397120	OTHER	MI	GROUP NPI
4	270381199	OTHER	MI	GROUP TAX ID

General Provider Information

NPI Number	:	1841282456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EWANAH D JOHNSON MD

Provider Business Mailing Address
First Line	:	1234 NAPIER AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2112
Country	:	US
Telephone Number	:	269-985-4632
Fax Number	:	269-985-4535

Provider Business Practice Location Address
First Line	:	1234 NAPIER AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2112
Country	:	US
Telephone Number	:	269-983-8300
Fax Number	:	269-985-4535

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/20/2015

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Directions to “ DR. EWANAH D JOHNSON MD” Practice Location

Language	Start Address	Practice Location

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