Provider Demographics
NPI:1215966528
Name:JOHNSON, HELENE M (MD)
Entity type:Individual
Prefix:DR
First Name:HELENE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6416 DEANS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERRIEN CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49102-9750
Mailing Address - Country:US
Mailing Address - Phone:269-471-7741
Mailing Address - Fax:269-471-1581
Practice Address - Street 1:42 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2203
Practice Address - Country:US
Practice Address - Phone:269-687-0808
Practice Address - Fax:269-687-0811
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301030791208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01-31142OtherPHP
MI1013408OtherCIGNA
MI0101151112OtherBLUE CROSS
MI0101151112OtherBLUE CROSS
MI1013408OtherCIGNA