Individual
STEPHEN JOHANTGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 355-5041
Mailing address
PO BOX 6276, DEPT. 20, INDIANAPOLIS, IN 46206-6276
(317) 802-3143
(317) 870-0499
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01031264
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100357450
—
IN
Enumeration date
07/09/2006
Last updated
11/17/2008
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