MEDICARE: DAVID EMANUEL 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	MD2004-0358	NM

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	:	1952389306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EMANUEL JOHNSON MD

Provider Business Mailing Address
First Line	:	40520 COUNTY HIGHWAY 34
Second Line	:
City	:	OGEMA
State	:	MN
Zip	:	56569-9612
Country	:	US
Telephone Number	:	218-983-4300
Fax Number	:	218-983-6307

Provider Business Practice Location Address
First Line	:	40520 COUNTY HIGHWAY 34
Second Line	:
City	:	OGEMA
State	:	MN
Zip	:	56569-9612
Country	:	US
Telephone Number	:	218-983-4300
Fax Number	:	218-983-6307

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	04/11/2022

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