Provider Demographics
NPI:1659544799
Name:ROSSI, JOHNNY C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:C
Last Name:ROSSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19841 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1315
Mailing Address - Country:US
Mailing Address - Phone:708-479-0790
Mailing Address - Fax:708-479-0792
Practice Address - Street 1:19841 WOLF RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1315
Practice Address - Country:US
Practice Address - Phone:708-479-0790
Practice Address - Fax:708-479-0792
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005327213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620925OtherBCBS
IN07001066AOtherLICENSE
INP00651652OtherRAILROAD MEDICARE
IL016005327OtherLICENSE
IL016005327OtherLICENSE
FR0720068OtherDEA
IL01620925OtherBCBS
IN07001066AOtherLICENSE