Provider Demographics
NPI:1437445640
Name:JOHNSON, RACHEL ELIZABETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21245 LORAIN RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2146
Mailing Address - Country:US
Mailing Address - Phone:440-356-1989
Mailing Address - Fax:415-356-5944
Practice Address - Street 1:21245 LORAIN RD
Practice Address - Street 2:SUITE 115
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2146
Practice Address - Country:US
Practice Address - Phone:440-356-1989
Practice Address - Fax:415-356-5944
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003564213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074363Medicaid
OHH129590Medicare UPIN