Provider Demographics
NPI:1588633119
Name:JOHNSON, KARIN (DO)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:700
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5638
Mailing Address - Country:US
Mailing Address - Phone:918-748-7630
Mailing Address - Fax:918-293-3105
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:700
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-748-7630
Practice Address - Fax:918-293-3105
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH69770Medicare UPIN