Individual
GWEN A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3055 HUBERTUS RD, HUBERTUS, WI 53033
(262) 628-9000
(262) 628-7255
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30420
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31555100
—
WI
01
—
P00836847
RR MEDICARE
WI
Enumeration date
07/07/2006
Last updated
12/06/2021
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