Individual
DEREK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDN
Contact information
Practice address
400 MACK AVE, DETROIT, MI 48201-2136
(313) 448-9600
Mailing address
400 MACK AVE, DETROIT, MI 48201-2136
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86080897
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86080897
REGISTERED DIETITIAN
MI
Enumeration date
06/28/2023
Last updated
06/28/2023
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