Provider Demographics
NPI:1629287040
Name:JOHNSON, SHALINI (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:JOHNSON
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 1:404 W SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1980
Mailing Address - Country:US
Mailing Address - Phone:906-482-5230
Mailing Address - Fax:906-482-5343
Practice Address - Street 1:404 W SHARON AVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1980
Practice Address - Country:US
Practice Address - Phone:906-482-5230
Practice Address - Fax:906-482-5343
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7958207W00000X
MI4301102140207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology