Provider Demographics
NPI:1053390849
Name:JOHNSON, STEVEN D (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9975 DELLWOOD RD N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9425
Mailing Address - Country:US
Mailing Address - Phone:651-429-7026
Mailing Address - Fax:651-292-2178
Practice Address - Street 1:927 CHURCHILL ST W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6605
Practice Address - Country:US
Practice Address - Phone:651-430-4617
Practice Address - Fax:651-292-2178
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND84282085R0202X
MN285242085R0202X
WI474132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN726873400Medicaid
MND80029Medicare UPIN
MN940000021Medicare PIN