Individual
DR. FREDERICK A JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5515 CLEVELAND AVE, SUITE 1, STEVENSVILLE, MI 49127-9670
(269) 429-6604
(269) 429-1715
Mailing address
5515 CLEVELAND AVE, SUITE 1, STEVENSVILLE, MI 49127-9670
(269) 429-6604
(269) 429-1715
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301038022
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013407
CIGNA
MI
01
—
12-31141
PHP
MI
05
—
2893915
—
MI
01
—
3501103141
BLUE CROSS
MI
01
—
370004513
RAILROAD MEDICARE
MI
Enumeration date
06/30/2006
Last updated
03/07/2023
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