Provider Demographics
NPI:1902212186
Name:JOHANSON, KARL-ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL-ERIC
Middle Name:
Last Name:JOHANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 SOUTH OCEAN BLVD.
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-272-1703
Mailing Address - Fax:
Practice Address - Street 1:205 CENTRE ISLAND ROAD.
Practice Address - Street 2:
Practice Address - City:CENTRE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11771
Practice Address - Country:US
Practice Address - Phone:516-922-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104944208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology