Provider Demographics
NPI:1992239222
Name:JOHNSTON, MICHAEL II
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JOHNSTON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13145 STATE ROAD 101
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9790
Mailing Address - Country:US
Mailing Address - Phone:765-914-3235
Mailing Address - Fax:
Practice Address - Street 1:13145 STATE ROAD 101
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-9790
Practice Address - Country:US
Practice Address - Phone:765-914-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program