Provider Demographics
NPI:1518982461
Name:JOHNSTONE, CANDICE AITKEN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:AITKEN
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:CANDICE
Other - Middle Name:LYNNE
Other - Last Name:AITKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-4400
Mailing Address - Fax:414-805-4369
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-4400
Practice Address - Fax:414-805-4369
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH126882085R0203X
WI551062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205309Medicaid
VT1011244Medicaid
WI1518982461Medicaid
NH30205309Medicaid
WI73601 1926Medicare PIN
I35746Medicare UPIN
VT1011244Medicaid
WI68086 0686Medicare PIN