Provider Demographics
NPI:1164622361
Name:JOHNSON, YETUNDE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:YETUNDE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:YETUNDE
Other - Middle Name:
Other - Last Name:SOLADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2736
Mailing Address - Country:US
Mailing Address - Phone:906-225-3985
Mailing Address - Fax:906-225-4562
Practice Address - Street 1:4200 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1417
Practice Address - Country:US
Practice Address - Phone:773-794-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1158042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry