Individual
DR. TAD MARK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3524 E MILWAUKEE ST, JANESVILLE, WI 53546-1626
(608) 756-7100
(608) 756-4700
Mailing address
3524 E MILWAUKEE ST, JANESVILLE, WI 53546-1626
(608) 756-7100
(608) 756-4700
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
25307
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659339919
BCBSWI
WI
05
—
1659339919
—
WI
05
—
30661900
—
WI
01
—
JOHNSTAD
MERCYCARE INSURANCE
WI
Enumeration date
05/03/2006
Last updated
09/06/2012
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