Provider Demographics
NPI:1316901754
Name:JOHNSON, JAMES R (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5400 FORT ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4632
Mailing Address - Country:US
Mailing Address - Phone:734-362-7100
Mailing Address - Fax:734-671-1768
Practice Address - Street 1:5400 FORT ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4632
Practice Address - Country:US
Practice Address - Phone:734-362-7100
Practice Address - Fax:734-671-1768
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H232900OtherBCBS
MI1158215544OtherBCBS - INDIVIDUAL
MI1158215544OtherBCN - INDIVIDUAL
MIE42955OtherHAP
MI110H232900OtherBCN
MI110H232900OtherBCBS
MI1158215544OtherBCN - INDIVIDUAL