Provider Demographics
NPI:1285854315
Name:JOHNSON, LANNY LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:LANNY
Middle Name:LEO
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4658 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2060
Mailing Address - Country:US
Mailing Address - Phone:517-347-8130
Mailing Address - Fax:517-347-8130
Practice Address - Street 1:4658 CHIPPEWA DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2060
Practice Address - Country:US
Practice Address - Phone:517-347-8130
Practice Address - Fax:517-347-8130
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301024011207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery