Provider Demographics
NPI:1598724767
Name:JOHNSON, STEVEN M (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 RIDGEWOOD CT.
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-1264
Mailing Address - Country:US
Mailing Address - Phone:765-265-5756
Mailing Address - Fax:
Practice Address - Street 1:908 RIDGEWOOD CT.
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-1264
Practice Address - Country:US
Practice Address - Phone:765-265-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002166A207V00000X
IADO-03490207V00000X
MO2015015367207V00000X
WI46941-21207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000977633OtherANTHEM
IN200182600Medicaid
IN000000335812OtherBLUE CROSS
IN259370109Medicare PIN
IN200182600Medicaid