Provider Demographics
NPI:1639277452
Name:JOHNSON, STEVEN PAUL (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
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 1:910 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1393
Mailing Address - Country:US
Mailing Address - Phone:616-527-2370
Mailing Address - Fax:616-527-3824
Practice Address - Street 1:910 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1393
Practice Address - Country:US
Practice Address - Phone:616-527-2370
Practice Address - Fax:616-527-3824
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISJ008296207Q00000X
MI5101008296207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002179OtherPHPMM
MI3081174OtherMOLINA
MI113081174Medicaid
MI1003025OtherMCLAREN
MI383218134OtherTRICARE
MI700C460060OtherBCBS GROUP NUMBER
MI0C46006048Medicare PIN
E41845Medicare UPIN