Individual
DR. DERICK MICHAEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3299 N WELLNESS DR, BLDG C, #150, HOLLAND, MI 49424-7269
(616) 738-3884
(616) 738-4432
Mailing address
3299 N WELLNESS DR, BLDG C, #150, HOLLAND, MI 49424-7269
(616) 738-3884
(616) 738-4432
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0102202412
VA
207X00000X
Orthopaedic Surgery Physician
Primary
L1206639
MI
390200000X
Student in an Organized Health Care Education/Training Program
58.001489
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0102202412
LICENSE
VA
Enumeration date
07/25/2008
Last updated
07/23/2014
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