Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 60593 | WI |
Y | 111NI0900X | Internist | 60593 | WI |
N | 207RC0200X | Critical Care Medicine | 60593 | WI |
NPI | 1023298072 |
---|---|
Provider Name | Vijay Johnson |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 03/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023298072 | (05) | WI |