Provider Demographics
NPI:1467423053
Name:JOHNSON, STEVEN DONALD (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DONALD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 637401
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263
Mailing Address - Country:US
Mailing Address - Phone:513-872-1888
Mailing Address - Fax:513-872-3616
Practice Address - Street 1:10498 MONTGOMERY RD.
Practice Address - Street 2:TRI-HEATH W LLC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-872-1888
Practice Address - Fax:513-872-3616
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078905J207V00000X
OH35-078905207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211074Medicaid
OHJO4039131Medicare PIN
OH4039136Medicare PIN
OH2211074Medicaid