Provider Demographics
NPI:1992887202
Name:MICHAEL W JOHNSON, MD, PC
Entity type:Organization
Organization Name:MICHAEL W JOHNSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-487-1000
Mailing Address - Street 1:101 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2323
Mailing Address - Country:US
Mailing Address - Phone:231-487-1000
Mailing Address - Fax:231-487-1002
Practice Address - Street 1:220 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1712
Practice Address - Country:US
Practice Address - Phone:906-643-0466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054807208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301054807OtherSTATE LICENSE
MI21407OtherMOLINA
MI0202410071OtherBCBSM PROVIDER ID#
MI0202410071OtherBCBSM PROVIDER ID#