Individual
MICHAEL B. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
347 SMITH AVE N, SUITE 602, SAINT PAUL, MN 55102-2387
(651) 227-0821
(651) 297-6597
Mailing address
2211 PARK AVE, MINNEAPOLIS, MN 55404-3711
(612) 871-1144
(612) 871-2012
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
43178
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000010
MEDICA PRIMARY
MN
01
—
1000215
MEDICA CHOICE
MN
01
—
1025272
PREFERREDONE
MN
01
—
1102768
AMERICA'S PPO
MN
01
—
140142
UCARE
MN
05
—
335402400
—
MN
01
—
34011200
MEDICAID - WISCONSIN
WI
01
—
91D32J0
BLUE SHIELD
MN
Enumeration date
08/10/2005
Last updated
07/05/2013
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