Provider Demographics
NPI:1225035710
Name:JOHNSON, TERRI SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14001 RIDGEDALE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1753
Mailing Address - Country:US
Mailing Address - Phone:952-249-2000
Mailing Address - Fax:952-249-2099
Practice Address - Street 1:14001 RIDGEDALE DR
Practice Address - Street 2:STE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1753
Practice Address - Country:US
Practice Address - Phone:952-249-2000
Practice Address - Fax:952-249-2099
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN28943207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN569885500Medicaid
MN569885500Medicaid
MNB58527Medicare UPIN