Provider Demographics
NPI:1184786824
Name:JOHNS, JEREMIAH L (MD)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:L
Last Name:JOHNS
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 1:109 MICHIGAN ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2302
Mailing Address - Country:US
Mailing Address - Phone:616-330-2522
Mailing Address - Fax:
Practice Address - Street 1:109 MICHIGAN ST NW STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2302
Practice Address - Country:US
Practice Address - Phone:616-330-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083940207L00000X, 207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00406843OtherRAILROAD MEDICARE
MII67635Medicare UPIN
MIP00406843OtherRAILROAD MEDICARE