Individual
DR. JOHANN ELI GUDJONSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, 1ST FLOOR TAUBMAN CTR RECP B, ANN ARBOR, MI 48109-5314
(734) 936-4054
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301082622
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301082622
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315015456
CONTROLLED SUBSTANCE LICE
MI
Enumeration date
03/23/2007
Last updated
03/19/2012
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