Individual
DR. JACOB DANIEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
15411 PARK VILLAGE BLVD, TAYLOR, MI 48180-4886
(646) 714-1984
Mailing address
15411 PARK VILLAGE BLVD, TAYLOR, MI 48180-4886
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5101020933
MI
2086S0129X
Vascular Surgery Physician
Primary
5101020933
MI
Other
Enumeration date
04/25/2012
Last updated
11/21/2015
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