Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 4301083940 | MI |
Y | 207P00000X | Emergency Physician | 4301083940 | MI |
N | 207PE0004X | Emergency Medical Services | 4301083940 | MI |
NPI | 1184786824 |
---|---|
Provider Name | Jeremiah L Johns |
First Address | Lansing, MI 48909-8016 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 21/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I67635 | (02) | MI |
P00406843 | RAILROAD MEDICARE (01) | MI |