Individual
MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
14700 LAKE SHORE DR, CHARLEVOIX, MI 49720-1931
(231) 547-4024
(231) 547-8088
Mailing address
14700 LAKE SHORE DR, CHARLEVOIX, MI 49720-1931
(231) 547-4024
(231) 547-8088
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704223453
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MJ223453
BLUE SHIELD STATE LICENSE
MI
Enumeration date
10/20/2006
Last updated
08/12/2019
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