Individual
GREGORY W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2122 HEALTH DR SW STE 110, WYOMING, MI 49519-9698
(616) 252-7494
(616) 252-7830
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301048643
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D16117
BCBS
MI
05
—
2662954
—
MI
Enumeration date
11/10/2005
Last updated
03/17/2018
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