Individual
MICHAEL A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 S 70TH ST, WEST ALLIS, WI 53214-3147
(414) 773-6600
(414) 773-6656
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 773-6600
(414) 773-6656
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32485000
—
WI
Enumeration date
03/28/2006
Last updated
06/18/2012
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