Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1822 | WI |
NPI | 1891902888 |
---|---|
Provider Name | Dr. Michael Lee Johnson |
First Address | Appleton, WI 54915-7803 |
Second Address | Appleton, WI 54915-7803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |