Provider Demographics
NPI:1306829445
Name:JOHNSON, MICHAEL WINTERS (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WINTERS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:1000 REMINGTON BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4707
Mailing Address - Country:US
Mailing Address - Phone:630-914-2468
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:101 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2323
Practice Address - Country:US
Practice Address - Phone:231-487-1000
Practice Address - Fax:231-487-1002
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054807208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3396567-10Medicaid
MI3396567-10Medicaid
MIP38080001Medicare PIN