Provider Demographics
NPI:1346836673
Name:DAVID L. JOHNSON, MD, LTD
Entity Type:Organization
Organization Name:DAVID L. JOHNSON, MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE/EMPLOYER S CORP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-332-4864
Mailing Address - Street 1:9833 CHOWEN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2748
Mailing Address - Country:US
Mailing Address - Phone:952-835-6391
Mailing Address - Fax:952-831-0530
Practice Address - Street 1:431 S 7TH ST STE 2402
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1801
Practice Address - Country:US
Practice Address - Phone:612-332-4864
Practice Address - Fax:952-831-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D73252OtherMEDICARE UPIN
MN315767900Medicaid
15-20048OtherMEDICA/UBH