Individual
BEVAN ELLIS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-8880
(317) 963-5492
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01086630A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
Other
Enumeration date
04/10/2020
Last updated
07/06/2022
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