Provider Demographics
NPI:1851381966
Name:ALAN D JOHNSON MD LTD
Entity Type:Organization
Organization Name:ALAN D JOHNSON MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-884-2002
Mailing Address - Street 1:2500 W HIGGINS RD
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7280
Mailing Address - Country:US
Mailing Address - Phone:847-884-2002
Mailing Address - Fax:847-884-2022
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 1150
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7280
Practice Address - Country:US
Practice Address - Phone:847-884-2002
Practice Address - Fax:847-884-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5250Medicare PIN
IL212162Medicare PIN