Individual
MR. MICHAEL JAMES JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1008 MINNEQUA AVE, PUEBLO, CO 81004-3733
(719) 560-5656
(719) 560-4715
Mailing address
445 E CHEYENNE MOUNTAIN BLVD STE C PMB 406, COLORADO SPRINGS, CO 80906-4570
(719) 538-8100
(719) 538-8003
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
595
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07005952
—
CO
01
—
970016858
RAILROAD MEDICARE
CO
Enumeration date
07/18/2006
Last updated
03/07/2023
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