Provider Demographics
NPI:1871504787
Name:JOHNSTON, JILL A (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4941 BENCHMARK CENTRE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2038
Mailing Address - Country:US
Mailing Address - Phone:618-624-9974
Mailing Address - Fax:618-624-9973
Practice Address - Street 1:4941 BENCHMARK CENTRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2038
Practice Address - Country:US
Practice Address - Phone:618-624-9974
Practice Address - Fax:618-624-9973
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics