Provider Demographics
NPI:1366702193
Name:JOHNSON, MICHAEL GUNNAR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GUNNAR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
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Mailing Address - Street 1:1501 W CHISHOLM ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1401
Mailing Address - Country:US
Mailing Address - Phone:989-356-5241
Mailing Address - Fax:989-356-8132
Practice Address - Street 1:401 LONG RAPIDS PLZ
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1394
Practice Address - Country:US
Practice Address - Phone:989-356-9333
Practice Address - Fax:989-356-0804
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2023-08-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant