Provider Demographics
NPI:1285640425
Name:JOHNSON, JANICE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10028 SKOKIE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1025
Mailing Address - Country:US
Mailing Address - Phone:224-233-1020
Mailing Address - Fax:224-233-1021
Practice Address - Street 1:10024 SKOKIE BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1025
Practice Address - Country:US
Practice Address - Phone:224-233-1020
Practice Address - Fax:224-233-1021
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036071673207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285640425OtherTYPE I NPI NUMBER ALSO
1285640425OtherTYPE I NPI NUMBER ALSO
1285640425OtherTYPE I NPI NUMBER ALSO