Provider Demographics
NPI:1114906963
Name:JOHNSON, KAREN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12201 PECOS ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3888
Mailing Address - Country:US
Mailing Address - Phone:303-457-4497
Mailing Address - Fax:303-254-4369
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:954-399-4645
Practice Address - Fax:855-855-2792
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01302124Medicaid
COCO303938Medicare PIN
E71110Medicare UPIN