Active NPI
Wallace Emanuel Johnson, MD
- Orthopaedic Surgery Physician
- Detroit, MI
National Provider Identifier
1639341076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 4301027092
- Practice address
- 273 Leeward CT
Detroit, MI 48207-5053 - Phone
- (313) 393-2741
- NPI assigned
- Mar 26, 2008
- Last updated
- Apr 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 4301027092 | MI | Primary |
Addresses
Primary practice location
273 Leeward CT
Detroit, MI 48207-5053
Mailing address
273 Leeward CT
Detroit, MI 48207-5053
Phone (313) 393-2741
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301027092 | MI | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209340800000",
"number": "1639341076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "273 LEEWARD CT",
"city": "DETROIT",
"state": "MI",
"postal_code": "482075053",
"telephone_number": "313-393-2741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "273 LEEWARD CT",
"city": "DETROIT",
"state": "MI",
"postal_code": "482075053",
"telephone_number": "313-393-2741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "WALLACE",
"middle_name": "EMANUEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-26",
"last_updated": "2008-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "MI",
"license": "4301027092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.