Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101020956 | MI |
NPI | 1407268105 |
---|---|
Provider Name | Emily Michelle Johnson |
First Address | Madison Heights, MI 48071-3487 |
Second Address | Madison Heights, MI 48071-3487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 29/05/2014 |