Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 4301053410 | MI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 4301053410 | MI |
N | 207NS0135X | Procedural Dermatology | 4301053410 | MI |
NPI | 1255428025 |
---|---|
Provider Name | Timothy M Johnson |
First Address | Ann Arbor, MI 48104-4141 |
Second Address | Ann Arbor, MI 48104-4141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1927590 | (05) | MI |
E35464 | (02) | MI |