Individual
MR. MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
1930 S BROAD ST, PHILADELPHIA, PA 19145-2328
(215) 339-4563
Mailing address
771 MANATAWNA AVE, PHILADELPHIA, PA 19128-1020
(215) 341-1410
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/31/2013
Last updated
07/31/2013
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