Provider Demographics
NPI:1841256971
Name:PETER E JOHNSON MD SC
Entity type:Organization
Organization Name:PETER E JOHNSON MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-296-5470
Mailing Address - Street 1:8901 W GOLF RD
Mailing Address - Street 2:#204
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:847-296-5470
Mailing Address - Fax:847-296-5474
Practice Address - Street 1:8901 W GOLF RD
Practice Address - Street 2:#204
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-296-5470
Practice Address - Fax:847-296-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2487670OtherAETNA PROVIDER #
IL4138183004OtherCIGNA PROVIDER #
IL1630266OtherBCBS PROVIDER ID
IL4138183004OtherCIGNA PROVIDER #