Johnson, Blake A

Johnson, Blake A is an individual health care provider with primary practice located at 5775 Wayzata Blvd Ste 190, St Louis Park MN 55416. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Johnson, Blake A can be contacted via phone (952) 541-1840.

Contact Information

Primary practice address
5775 Wayzata Blvd Ste 190 St Louis Park MN 55416
Phone: (952) 541-1840
Fax: (952) 513-6880
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 39490 Minnesota

Profile Details

NPI number 1811964174
LBN Legal business name Johnson, Blake A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 7th, 2006
Last updated Feb 17th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811964174 NPPES
Minnesota MEDICAID 205022600

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