Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036-094274 | IL |
NPI | 1003823881 |
---|---|
Provider Name | Dr. Kimberly Lois Johnson |
First Address | Chicago, IL 60628-3624 |
Second Address | Chicago, IL 60615-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 26/04/2021 |