Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036.142615 | IL |
NPI | 1023457512 |
---|---|
Provider Name | Dr. Brooke T Johnson |
First Address | Chicago, IL 60612-7242 |
Second Address | Chicago, IL 60612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 11/07/2018 |