# C. MICHAEL JOHNSON, D.O,INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679746895
- **Authorized official:** MRS. SUSIE MONROE (OFFICE MANAGER)
- **Authorized official phone:** (918) 587-2389

## Contact information

- **Practice address:** 802 S JACKSON AVE, SUITE 110, TULSA, OK 74127-9015
- **Practice address phone:** (918) 587-2389
- **Practice address fax:** (918) 587-4389
- **Mailing address:** 802 SO. JACKSON AVE, SUITE 110, TULSA, OK 74127-8921
- **Mailing address phone:** (918) 587-2389
- **Mailing address fax:** (918) 587-4389

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 1716 | OK | Yes |

## Other

- **Enumeration date:** 04/09/2008
- **Last updated:** 11/18/2008