Individual
BEAU JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-5000
Mailing address
2913 N IONIA RD, VERMONTVILLE, MI 49096-9597
(517) 588-9833
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601012454
MI
Other
Enumeration date
05/21/2024
Last updated
06/03/2024
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