Provider Demographics
NPI:1043299555
Name:JOHNSON, CRAIG H (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:H
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 1:310 SMITH AVE N STE 303
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2393
Mailing Address - Country:US
Mailing Address - Phone:651-241-5111
Mailing Address - Fax:
Practice Address - Street 1:280 SMITH AVE N STE 700
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2972
Practice Address - Country:US
Practice Address - Phone:651-241-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60797-20208200000X
MN30848208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35175400Medicaid
MN240003573OtherRAILROAD MEDICARE
MN240003573OtherRAILROAD MEDICARE
WI35175400Medicaid