Provider Demographics
NPI:1528050077
Name:JOHNSON, WILLIAM TODD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TODD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NE MULBERRY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6017
Mailing Address - Country:US
Mailing Address - Phone:816-524-1007
Mailing Address - Fax:816-524-1988
Practice Address - Street 1:301 NE MULBERRY ST STE 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6017
Practice Address - Country:US
Practice Address - Phone:816-524-1007
Practice Address - Fax:816-524-1988
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103076208800000X
KS0427384208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209695014Medicare ID - Type UnspecifiedMEDICARE NUMBER
KSF77592Medicare UPIN
KS100303990AMedicare ID - Type UnspecifiedMEDICARE NUMBER