Individual
ROBERT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 W LAKE ST, MINNEAPOLIS, MN 55408-3117
(612) 545-9000
Mailing address
7626 CARNELIAN LN, EDEN PRAIRIE, MN 55346-4345
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22027
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
589790400
—
MN
Enumeration date
06/16/2006
Last updated
07/08/2007
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