Basic Information
| Provider Information | |||||||||
| NPI: | 1033256052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ALISA | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5655 HUDSON DR STE 210 | ||||||||
| Address2: | ARIS RADIOLOGY | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442364455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306551869 | ||||||||
| FaxNumber: | 3306553828 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 S CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | MERRILL | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544523404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623386176 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | DR.0057838 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 55894-20 | WI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000037070 | 01 | WI | MEDICARE PTAN | OTHER |