Provider Demographics
NPI:1588633747
Name:JOHNSON, JOANN E (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2910 CENTRE POINTE DRIVE 35121A
Mailing Address - Street 2:CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:2425 CHICAGO AVENUE SOUTH
Practice Address - Street 2:CHILDRENS PRIMARY CLINIC TAMS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-6125
Practice Address - Fax:612-872-2338
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN27885208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F49285Medicare UPIN