Provider Demographics
NPI:1306831938
Name:HOUSTON, JOHN THE BAPTIST (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THE BAPTIST
Last Name:HOUSTON
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:2400 N ASHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2021
Practice Address - Country:US
Practice Address - Phone:312-632-0032
Practice Address - Fax:773-409-5089
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-100082208800000X
IL0361000822088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100082Medicaid
IL01634125OtherBCBS PROVIDER ID
IN100013160BMedicaid
IL036100082Medicaid
IN100013160BMedicaid