Individual
KEITH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9855 HOSPITAL DR STE 102, MAPLE GROVE, MN 55369-4648
(763) 581-5900
(763) 581-5901
Mailing address
2001 VAIL AVE, CHARLOTTE, NC 28207-1248
(704) 304-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
238295
NC
207Q00000X
Family Medicine Physician
Primary
69882
MN
Other
Enumeration date
03/23/2018
Last updated
07/29/2021
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