Individual
AMY W JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1001 W 10TH ST, OPW M200, INDIANAPOLIS, IN 46202-2859
(317) 656-4260
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02004606A
IN
207R00000X
Internal Medicine Physician
11016694A
IN
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
02004606A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001083932
ANTHEM PTAN
IN
01
—
000001103600
ANTHEM PTAN
IN
01
—
000001104167
ANTHEM PTAN
IN
05
—
201102260
—
IN
Enumeration date
06/28/2012
Last updated
03/25/2025
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