Individual
DR. CHARLES MARVIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
10244 W 7 MILE RD, DETROIT, MI 48221-1904
(313) 862-5800
(313) 862-2865
Mailing address
10244 W 7 MILE RD, DETROIT, MI 48221-1904
(313) 862-5800
(313) 862-2865
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901001211
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480H232610
BLUE CROSS
MI
01
—
4858250260
BCBSM
MI
05
—
4866541
—
MI
01
—
CJ001211
LICENSE NUMBER
MI
Enumeration date
10/06/2006
Last updated
02/05/2009
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