Provider Demographics
NPI:1851731590
Name:JOHNSON, BENJAMIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:E
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 1:2740 W FOSTER AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3532
Mailing Address - Country:US
Mailing Address - Phone:773-293-4001
Mailing Address - Fax:773-293-3203
Practice Address - Street 1:2740 W FOSTER AVE STE 213
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3532
Practice Address - Country:US
Practice Address - Phone:773-293-4001
Practice Address - Fax:773-293-3203
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036149861208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery