Individual
MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 UNIVERSITY BLVD, UH 3005, INDIANAPOLIS, IN 46202-5149
(317) 944-2167
(317) 944-2305
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01034992
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098980
—
IN
Enumeration date
08/22/2006
Last updated
01/13/2021
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