Individual
BRENT M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5656 W US HIGHWAY 10, LUDINGTON, MI 49431-2454
(231) 843-2543
(231) 843-2547
Mailing address
5656 W US HIGHWAY 10, LUDINGTON, MI 49431-2454
(231) 843-2543
(231) 843-2547
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003020
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601003020
MEDICAL LICENSE
MI
01
—
CJ0662
MEDICARE RAILROAD
MI
Enumeration date
08/01/2005
Last updated
08/08/2016
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