Provider Demographics
NPI:1497866073
Name:KEITH A. JOHNSTONE M.D., P.C.
Entity Type:Organization
Organization Name:KEITH A. JOHNSTONE M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-355-4545
Mailing Address - Street 1:26206 W 12 MILE RD
Mailing Address - Street 2:201
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1754
Mailing Address - Country:US
Mailing Address - Phone:248-355-4545
Mailing Address - Fax:248-355-3855
Practice Address - Street 1:26206 W 12 MILE RD
Practice Address - Street 2:201
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1754
Practice Address - Country:US
Practice Address - Phone:248-355-4545
Practice Address - Fax:248-355-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048096207RI0011X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3500119/10Medicaid
MIOM71230Medicare ID - Type Unspecified
MIA93545Medicare UPIN
P34650001Medicare PIN