Basic Information
| Provider Information | |||||||||
| NPI: | 1417335050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KEARY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 43 | ||||||||
| Address2: | ROUTE 10202 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554400043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122621166 | ||||||||
| FaxNumber: | 3305805513 | ||||||||
| Practice Location | |||||||||
| Address1: | 1324 5TH ST N | ||||||||
| Address2: | |||||||||
| City: | NEW ULM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072175000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2015 | ||||||||
| LastUpdateDate: | 05/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 57.026963 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.