Organization
MICHAEL W JOHNSON, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA BAYS (OFFICE MANAGER)
(231) 487-1000
Entity
Organization
Contact information
Practice address
220 BURDETTE ST, SAINT IGNACE, MI 49781-1712
(906) 643-0466
Mailing address
101 W MITCHELL ST, PETOSKEY, MI 49770-2323
(231) 487-1000
(231) 487-1002
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301054807
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202410071
BCBSM PROVIDER ID#
MI
01
—
21407
MOLINA
MI
01
—
4301054807
STATE LICENSE
MI
Enumeration date
10/19/2006
Last updated
08/22/2020
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