Organization
CHARLES M JOHNSON PODIATRIST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES M. JOHNSON DPM (DIRECTOR/OWNER)
(313) 862-5800
Entity
Organization
Contact information
Practice address
10244 W 7 MILE RD, DETROIT, MI 48221-1904
(313) 862-5800
(313) 862-2865
Mailing address
10244 W 7 MILE RD, DETROIT, MI 48221-1904
(313) 862-5800
(313) 862-2865
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
CJ001211
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P47360
MEDICARE GROUP
MI
01
—
480H232610
BLUE CROSS
MI
05
—
4866541
—
MI
Enumeration date
01/10/2007
Last updated
05/13/2015
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