Joel A Johnson, M.D.
Individual provider Active NPI Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Ishpeming, MI
NPI 1689658973 · NPPES record last updated Apr 26, 2012
Key facts
- NPI
- 1689658973
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X
- License
- 4301057398 (MI)
- Practice address
- 901 Lakeshore Dr.
Ishpeming, MI 49849 - Phone
- (906) 485-2696
- Fax
- (906) 485-2728
- NPI assigned
- Dec 1, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 4301057398 | MI | Yes |
Addresses
Primary practice location
901 Lakeshore Dr.
Ishpeming, MI 49849
Mailing address
901 Lakeshore Dr
Ishpeming, MI 49849
Phone (906) 485-2696
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3123800 | Medicaid | MI | |
| 3305200671 | Other | MI | BLUE CROSS BLUE SHIELD MI |
Other providers in Ishpeming, MI
- Luke Anthony Jacobson
- James E Frounfelter DDS PC
- Ninamarie Janofski
- Laura Jason
- Jean L Farbod DDS PLC
- Theresa Johnson
- Judd C Johnston
- Abigail Johnstone
- Joseph Michael Heidelberger
- JPP Management of Negaunee LLC
All providers in Ishpeming, MI · Thoracic Surgery (Cardiothoracic Vascular Surgery) 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 Apr 26, 2012. 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.