Provider Demographics
NPI:1154524742
Name:JOHNSON, MICHAEL ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERNEST
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:HOSPITALIST PROGRAM
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3417
Mailing Address - Country:US
Mailing Address - Phone:314-205-6736
Mailing Address - Fax:314-576-2319
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6736
Practice Address - Fax:314-576-2319
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2014-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2008002672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO149920073Medicare PIN