Individual
TODD M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13000 E 136TH ST, FISHERS, IN 46037-9478
(317) 678-1700
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01055574A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300015669
—
IN
01
—
959090188
MEDICARE PTAN
IN
01
—
Q00523653
RAILROAD PTAN
IN
Enumeration date
12/14/2005
Last updated
05/21/2024
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