Individual
MARK E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 SIXTH AVE N, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 252-5131
(320) 255-5714
Mailing address
1200 SIXTH AVE N, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 252-5131
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
33783
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110104487
RR MEDICARE
—
01
—
110904
U CARE
—
01
—
2114001
FIRST HEALTH PLAN
—
01
—
2529937
MEDICA HEALTH PLANS
—
01
—
600885
ARAZ GROUP AMERICAS PPO
—
01
—
686002800
MEDICAL ASSISTANCE
—
05
—
686002800
—
MN
01
—
6D71JO
BLUE CROSS BLUE SHIELD
—
01
—
986014
PREFERRED ONE
—
01
—
HP25456
HEALTH PARTNERS
—
Enumeration date
08/16/2005
Last updated
08/26/2024
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