Organization
JOEL A JOHNSON, M.D., P.C.
Active
Other names
Upper Great Lakes Vascular, P.C
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL A JOHNSON M.D. (PRESIDENT)
(906) 225-7701
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE, STE 215, MARQUETTE, MI 49855-2675
(906) 225-7701
(906) 225-7705
Mailing address
1414 W FAIR AVE, STE 348, MARQUETTE, MI 49855-2675
(906) 225-3964
(906) 226-3875
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301057398
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330E21025
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
11/29/2005
Last updated
08/22/2020
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