Individual
MISTY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
(920) 907-7500
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35760
WI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
35760
WI
208M00000X
Hospitalist Physician
Primary
35760
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32249300
—
WI
Enumeration date
09/09/2005
Last updated
08/02/2024
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