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1841379187

NPI Code Detail

MEDICARE: DR. DWAYNE EDWARD JOHNSON M.D.

MEDICARE: DR. DWAYNE EDWARD JOHNSON M.D.

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	208000000X	Pediatrics Physician	01073977A	IN
2	208000000X	Pediatrics Physician	28666	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611336483	OTHER		COMMONWEALTH HEALTH ALLIA
2	611336483	OTHER		MAIL HANDLERS BENEFIT PLA
3	611336483	OTHER		PPONEXT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	611336483	OTHER		UNITED HEALTHCARE
7	2435769000	OTHER		PASSPORT ADVANTAGE
8	611336483	OTHER		HUMANA HEALTH PLAN, INC.
9	1087687	OTHER		PASSPORT HEALTH PLAN
10	611336483	OTHER		PREFERRED HEALTH PLAN
11	000000052119	OTHER		ANTHEM
12	2133380	OTHER		AETNA
13	611336483	OTHER		4MOST HEALTH NETWORK
14	87043	OTHER		FIRST HEALTH NETWORK

General Provider Information

NPI Number	:	1841379187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWAYNE EDWARD JOHNSON M.D.

Provider Business Mailing Address
First Line	:	148 W HIVELY AVE
Second Line	:	SUITE 1
City	:	ELKHART
State	:	IN
Zip	:	46517-2191
Country	:	US
Telephone Number	:	574-350-2500
Fax Number	:	574-350-2598

Provider Business Practice Location Address
First Line	:	236 SIMPSON AVE
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-4666
Country	:	US
Telephone Number	:	574-584-7373
Fax Number	:	574-293-3744

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	11/03/2023

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Directions to “ DR. DWAYNE EDWARD JOHNSON M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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