Johnson, Gary Keith
Johnson, Gary Keith is an sole proprietor health care provider with primary practice located at 630 S Saginaw St , Flint MI 48502-1525. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Johnson, Gary Keith can be contacted via phone (810) 257-3155.Contact Information
Primary practice address
630 S Saginaw St
Flint MI 48502-1525
Phone: (810) 257-3155
Fax: (810) 257-3147
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 4301049794 | Michigan |
Profile Details
| NPI number | 1083752802 |
|---|---|
| LBN Legal business name | Johnson, Gary Keith |
| Credentials | M.D., M.P.H. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 2nd, 2007 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083752802 | NPPES |
| Michigan | MEDICAID | 3149584 | |
| Michigan | MEDICAID | 3149593 | |
| Michigan | MEDICAID | 2837685 |
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