Provider Demographics
NPI:1982706560
Name:JOHNSON, HEIDI J (DO)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6208
Practice Address - Street 1:2035 ASHER CT
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8480
Practice Address - Country:US
Practice Address - Phone:517-337-8568
Practice Address - Fax:517-337-8577
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0853301194OtherBCBS INDIVIDUAL PIN #
MI200000002863OtherPHP
MI4928573Medicaid
MIG97752Medicare UPIN
MI200000002863OtherPHP