Individual
DAVID MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
611 E DOUGLAS RD STE 137, MISHAWAKA, IN 46545-1464
(574) 335-6214
(574) 335-6215
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02005551A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02005551A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02005551A
STATE LICENSE
IN
Enumeration date
06/05/2017
Last updated
11/08/2023
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