Provider Demographics
NPI:1942492988
Name:JOHNSON, CYBELE D (DO)
Entity Type:Individual
Prefix:
First Name:CYBELE
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:1601 SAINT FRANCIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3383
Practice Address - Country:US
Practice Address - Phone:612-428-3535
Practice Address - Fax:612-428-3599
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN50015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine