Individual
KENNETH M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-078597
IL
207P00000X
Emergency Medicine Physician
Primary
53595-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010056900
MEDICARE RAILROAD
WI
05
—
104161654
—
MI
05
—
32019000
—
WI
01
—
930070593
MEDICARE RAILROAD
WI
01
—
930077765
MEDICARE RAILROAD
WI
01
—
930079989
MEDICARE RAILROAD
WI
01
—
930080950
MEDICARE RAILROAD
WI
01
—
930106598
MEDICARE RAILROAD
WI
Enumeration date
06/16/2006
Last updated
12/20/2021
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