Provider Demographics
NPI:1427132877
Name:JOHNSON, JANE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 E MICHIGAN AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2894
Mailing Address - Country:US
Mailing Address - Phone:517-485-3789
Mailing Address - Fax:517-485-4789
Practice Address - Street 1:8392 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1867
Practice Address - Country:US
Practice Address - Phone:810-695-1770
Practice Address - Fax:814-069-5664
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine