Provider Demographics
NPI:1104042613
Name:JOHNSON, BRIDGET H (MD)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:H
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:EILEEN
Other - Last Name:HEGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 S EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4257
Mailing Address - Country:US
Mailing Address - Phone:262-787-4050
Mailing Address - Fax:262-439-7683
Practice Address - Street 1:725 S AMERICAN AVENUE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-544-2011
Practice Address - Fax:262-439-7683
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051278207R00000X
WI51994-20207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine