Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301107206 | MI |
N | 208600000X | Surgeon | 4301107206 | MI |
N | 2086S0102X | Surgical Critical Care | 4301107206 | MI |
Y | 2086S0120X | Pediatric Surgery | 4301107206 | MI |
NPI | 1366762213 |
---|---|
Provider Name | Kevin N Johnson |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 18/08/2020 |