Provider Demographics
NPI:1942291745
Name:CRAIG R JOHNSTON MD INC
Entity Type:Organization
Organization Name:CRAIG R JOHNSTON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-352-9171
Mailing Address - Street 1:1311 N ARLINGTON AVE
Mailing Address - Street 2:101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3286
Mailing Address - Country:US
Mailing Address - Phone:317-352-9171
Mailing Address - Fax:317-353-0287
Practice Address - Street 1:1311 N ARLINGTON AVE
Practice Address - Street 2:101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3286
Practice Address - Country:US
Practice Address - Phone:317-352-9171
Practice Address - Fax:317-353-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN115340Medicare ID - Type Unspecified