Provider Demographics
NPI:1083605034
Name:JOHNSON, ALAN D (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
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 1:2500 W HIGGINS RD
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7280
Mailing Address - Country:US
Mailing Address - Phone:847-884-2002
Mailing Address - Fax:847-884-2022
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 1150
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-884-2002
Practice Address - Fax:847-884-2022
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053301208M00000X
IL036-053301207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053301Medicaid
ILIL5250001Medicare PIN
IL036053301Medicaid
ILD14350Medicare UPIN