Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 20554 | WI |
N | 207P00000X | Emergency Physician | 4301500256 | MI |
N | 207P00000X | Emergency Physician | MD-45839 | IA |
N | 207P00000X | Emergency Physician | MD00027313 | WA |
Y | 207RC0200X | Critical Care Medicine | 20554 | WI |
NPI | 1013250737 |
---|---|
Provider Name | Mr. Brad A. Johnson |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Milwaukee, WI 53215-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100174759 | (05) | WI |
1036645 | (05) | WA |