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NPI Code Detail

MEDICARE: MICHAEL W JOHNSON, MD, PC

MEDICARE: MICHAEL W JOHNSON, MD, PC
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
1208600000XSurgery Physician4301054807MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14301054807OTHERMISTATE LICENSE
221407OTHERMIMOLINA
30202410071OTHERMIBCBSM PROVIDER ID#

General Provider Information

NPI Number : 1992887202
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL W JOHNSON, MD, PC
Provider Business Mailing Address
First Line : 101 W MITCHELL ST
Second Line :
City : PETOSKEY
State : MI
Zip : 49770-2323
Country : US
Telephone Number : 231-487-1000
Fax Number : 231-487-1002
Provider Business Practice Location Address
First Line : 220 BURDETTE ST
Second Line :
City : SAINT IGNACE
State : MI
Zip : 49781-1712
Country : US
Telephone Number : 906-643-0466
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : TINA BAYS
Credential :
Telephone Number : 231-487-1000
Provider Enumeration Date : 10/19/2006
Last Update Date : 08/22/2020

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