Individual
MATTHEW S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 N UNIVERSITY BLVD UH 290, INDIANAPOLIS, IN 46202-5253
(317) 944-1850
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01042315
IN
2085R0204X
Vascular & Interventional Radiology Physician
01042315
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01042315A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100465380
—
IN
01
—
300050672
RAILROAD MEDICARE
IN
01
—
959090W8
MEDICARE PTAN
IN
Enumeration date
06/14/2006
Last updated
02/13/2024
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