Provider Demographics
NPI:1619193109
Name:JOHNSON, BENJAMIN C (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C
Last Name:JOHNSON
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 1:222 S GREENLEAF
Mailing Address - Street 2:LAKE COUNTY HEAD & NECK SPECIALISTS SC SUITE 106
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-662-4442
Mailing Address - Fax:847-662-4446
Practice Address - Street 1:222 S GREENLEAF
Practice Address - Street 2:LAKE COUNTY HEAD & NECK SPECIALISTS SC SUITE 106
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-662-4442
Practice Address - Fax:847-662-4446
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117490207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology