Provider Demographics
NPI:1740393495
Name:JOHNSON, MARCIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:707 LAKE COOK RD
Mailing Address - Street 2:SUITE #280
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5613
Mailing Address - Country:US
Mailing Address - Phone:847-480-0004
Mailing Address - Fax:847-480-8707
Practice Address - Street 1:707 LAKE COOK ROAD
Practice Address - Street 2:SUITE #280
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4909
Practice Address - Country:US
Practice Address - Phone:847-480-0004
Practice Address - Fax:847-480-8707
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-093410207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology