Michael P Johnson, DO – Family Medicine Physician

Key facts

NPI: 1306058680
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 5101016875 (MI)
Practice address: 1480 W Center Rd
Essexville, MI 48732-2143
Phone: (989) 895-4625
Fax: (989) 895-4626
NPI assigned: May 7, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

McLaren Bay Region Psychologist · Essexville, MI · NPI 1013056233

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Osteopathy

State licenses

License	State	Type	Specialty
5101016875	MI	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
McLaren Bay Region		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	5101016875	MI	Yes

Addresses

Primary practice location

1480 W Center Rd
Essexville, MI 48732-2143

Mailing address

401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-1000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306058680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-1000",
            "fax_number": "810-342-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 W CENTER RD",
            "city": "ESSEXVILLE",
            "state": "MI",
            "postal_code": "487322143",
            "telephone_number": "989-895-4625",
            "fax_number": "989-895-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101016875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Essexville, MI

All providers in Essexville, MI · Family Medicine Physician in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.