Provider Demographics
NPI:1497932750
Name:JOHNSON PODIATRY ASSOCIATES PC
Entity Type:Organization
Organization Name:JOHNSON PODIATRY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:D
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-351-7640
Mailing Address - Street 1:1500 WATERTOWER PL
Mailing Address - Street 2:STE 300
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8049
Mailing Address - Country:US
Mailing Address - Phone:517-351-7640
Mailing Address - Fax:517-351-9462
Practice Address - Street 1:1500 WATERTOWER PL
Practice Address - Street 2:STE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8048
Practice Address - Country:US
Practice Address - Phone:517-351-7640
Practice Address - Fax:517-351-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
MI590100788213ES0131X
MI5901001391213ES0131X
MI5901001875213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP55340002Medicare PIN
MI0P55340Medicare PIN
MIP55340001Medicare PIN
MIP55340003Medicare PIN