Provider Demographics
NPI:1477549699
Name:JOHANSON, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:JOHANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1905 E, HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM, INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-1460
Mailing Address - Fax:608-364-1455
Practice Address - Street 1:1905 E, HUEBBE PARKWAY
Practice Address - Street 2:BELOIT HEALTH SYSTEM, INC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-1460
Practice Address - Fax:608-364-1455
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI27679-020207RG0100X
IL036-082777207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082777Medicaid
WI1477549699Medicaid
WI1477549699Medicaid
B53875Medicare UPIN