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Individual

DR. STACEY JOHNSTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
615 N MICHIGAN ST FL 1, SOUTH BEND, IN 46601-1033
(574) 647-3050
(574) 647-1094
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3437

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
001842
GA
207Q00000X
Family Medicine Physician
01096098A
IN
207Q00000X
Family Medicine Physician
ME137361
FL
208M00000X
Hospitalist Physician
Primary
ME137361
FL

Other

Enumeration date
08/30/2007
Last updated
11/07/2025
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