Basic Information
| Provider Information | |||||||||
| NPI: | 1821112822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | LYLE | ||||||||
| MiddleName: | ORLAND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8146 | ||||||||
| Address2: | |||||||||
| City: | HORSESHOE BAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786578146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8305960559 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2025 E RIVER PKWY | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554143604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125966100 | ||||||||
| FaxNumber: | 6125966102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207X00000X | 18020 | MN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.