Individual
TISA M. JOHNSON-HOOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301075433
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
418507510
—
MI
01
—
700H262280
BLUE CROSS-BLUE CROSS
—
01
—
TJ075433
CHAMPUS-CHAMPUS
—
Enumeration date
01/04/2007
Last updated
03/16/2021
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