Individual
KENNETH S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
PO BOX 22067, LANSING, MI 48909-8016
(616) 975-1845
(616) 285-0846
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301057997
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301057997
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930077745
RAILROAD MEDICARE
MI
01
—
P00411572
RAILROAD MEDICARE
MI
Enumeration date
08/02/2006
Last updated
08/21/2019
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