Individual
DR. SCOTT HAZLEHURST JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 GENESYS PKWY STE 3452, GRAND BLANC, MI 48439-8065
(248) 849-2600
(248) 849-2610
Mailing address
16001 W 9 MILE RD # 3, SOUTHFIELD, MI 48075-4818
(248) 849-2600
(248) 849-2610
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
36390
SC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301087166
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3303312811
BCBS INDIVIDUAL PIN
MI
05
—
4855726
—
MI
05
—
PENDING
—
SC
Enumeration date
09/21/2006
Last updated
07/15/2021
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