Provider Demographics
NPI:1629097530
Name:JOHNSTONE, CHERYL ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANNE
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1646
Mailing Address - Country:US
Mailing Address - Phone:249-349-1900
Mailing Address - Fax:248-380-9365
Practice Address - Street 1:308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1646
Practice Address - Country:US
Practice Address - Phone:249-349-1900
Practice Address - Fax:248-380-9365
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI130912OtherPREFERRED CHOICES
MIOH24993OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
MICB2510OtherRAILROAD MEDICARE
MI0M94870011Medicare ID - Type Unspecified
MI130912OtherPREFERRED CHOICES