Provider Demographics
NPI:1659431484
Name:JOHNSON-TOWSON, MICHELE A (MD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:A
Last Name:JOHNSON-TOWSON
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 1:1338 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3366
Mailing Address - Country:US
Mailing Address - Phone:813-264-2288
Mailing Address - Fax:813-264-1677
Practice Address - Street 1:1338 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3366
Practice Address - Country:US
Practice Address - Phone:813-264-2288
Practice Address - Fax:813-264-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371172200Medicaid
FLF42127Medicare UPIN