MEDICARE: WENDI A 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	208000000X	Pediatrics Physician	42414	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	370015800	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	127726	OTHER	U CARE
2	COMP	OTHER	CHAMPUS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	COMP	OTHER	MMSI
6	1200672	OTHER	MEDICA HEALTH PLANS
7	2115882	OTHER	FIRST HEALTH PLAN
8	940644	OTHER	ARAZ GROUP AMERICAS PPO
9	1023002	OTHER	PREFERRED ONE
10	86D69HO	OTHER	BLUE CROSS BLUE SHIELD
11	COMP	OTHER	ONE HEALTH PLAN GREAT WES
12	HP30134	OTHER	HEALTH PARTNERS

General Provider Information

NPI Number	:	1861483711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDI A JOHNSON MD

Provider Business Mailing Address
First Line	:	320 E MAIN ST
Second Line	:
City	:	CROSBY
State	:	MN
Zip	:	56441-1645
Country	:	US
Telephone Number	:	218-546-7000
Fax Number	:	218-546-4400

Provider Business Practice Location Address
First Line	:	320 E MAIN ST
Second Line	:
City	:	CROSBY
State	:	MN
Zip	:	56441-1645
Country	:	US
Telephone Number	:	218-546-7000
Fax Number	:	218-546-4400

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	11/19/2020

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Directions to “ WENDI A JOHNSON MD” Practice Location

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