Basic Information
Provider Information
NPI: 1659511038
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSON
FirstName: KAREN
MiddleName: JO
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 36123 SCHOOLCRAFT RD
Address2:  
City: LIVONIA
State: MI
PostalCode: 481501216
CountryCode: US
TelephoneNumber: 9136601616
FaxNumber:  
Practice Location
Address1: 20333 W 151ST ST
Address2:  
City: OLATHE
State: KS
PostalCode: 660615350
CountryCode: US
TelephoneNumber: 9137914200
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/25/2009
LastUpdateDate: 04/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X2010008200MON Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X05-34247KSY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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