Provider Demographics
NPI:1437393402
Name:JOHNSON, MAGGI LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGGI
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAGGI
Other - Middle Name:LEIGH
Other - Last Name:ENGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14688 EVERTON AVE N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-6064
Mailing Address - Country:US
Mailing Address - Phone:651-326-7701
Mailing Address - Fax:651-326-1190
Practice Address - Street 1:14688 EVERTON AVE N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-6064
Practice Address - Country:US
Practice Address - Phone:651-326-7701
Practice Address - Fax:651-326-1190
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine