Provider Demographics
NPI:1548221385
Name:ZACHARIAS, JOHNSON K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNSON
Middle Name:K
Last Name:ZACHARIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1222 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3406
Mailing Address - Country:US
Mailing Address - Phone:810-985-9681
Mailing Address - Fax:810-985-3590
Practice Address - Street 1:1222 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3406
Practice Address - Country:US
Practice Address - Phone:810-985-9681
Practice Address - Fax:810-985-3590
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031635207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG46015005Medicare PIN