Individual
MICHAEL LEWIS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2789 ORTIZ AVE, FORT MYERS, FL 33905-7806
(239) 791-1586
Mailing address
3736 EVANS AVE, FORT MYERS, FL 33901
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J525552903890
DRIVER'S LICENSE
FL
Enumeration date
10/02/2013
Last updated
10/02/2013
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