Individual
BRADLEY S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1850 BEAM AVE, MAPLEWOOD, MN 55109-1162
(651) 241-9500
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27882
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230568200
—
MN
Enumeration date
06/30/2006
Last updated
12/12/2011
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