Provider Demographics
NPI:1205857901
Name:JOHNSON, TODD CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:CHRISTOPHER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 MONTEREY TRL
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5284
Mailing Address - Country:US
Mailing Address - Phone:605-422-1130
Mailing Address - Fax:
Practice Address - Street 1:101 TOWER RD STE 103
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5007
Practice Address - Country:US
Practice Address - Phone:605-217-7246
Practice Address - Fax:605-217-4878
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4163207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1141994Medicaid
SD5701170Medicaid
IA1141994Medicaid
SD100590Medicare PIN