Provider Demographics
NPI:1508959453
Name:JOHNSON, DANA E (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS MMC 39
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-672-7211
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHY PWB FOURTH FLOOR ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-672-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0052117Medicaid
MN4774518OtherMEDICA-PRIMARY
MN022574OtherFAIRIVEW
MN101184OtherU CARE
MN1009158OtherPREFERRED ONE
MN228293300Medicaid
MNHP13613OtherHEALTH PARTNERS
604716OtherARAZ
IA0972521Medicaid
MN4724899OtherMEDICA-CHOICE
MN2T286JOOtherBLUE CROSS BLUE SHIELD
MN4774518OtherMEDICA-PRIMARY
MN2T286JOOtherBLUE CROSS BLUE SHIELD