Provider Demographics
NPI:1083625818
Name:JOHANNING, CHAD D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:D
Last Name:JOHANNING
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 1:4951 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2090
Mailing Address - Country:US
Mailing Address - Phone:785-841-6540
Mailing Address - Fax:785-841-3129
Practice Address - Street 1:4951 W 18TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2090
Practice Address - Country:US
Practice Address - Phone:785-841-6540
Practice Address - Fax:785-841-3129
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201232910AMedicaid