Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 036110291 | IL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 036110291 | IL |
NPI | 1033208418 |
---|---|
Provider Name | Dr. Todd Andrew Johnson |
First Address | Chicago, IL 60642-1501 |
Second Address | Chicago, IL 60642-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 03/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036110291 | (05) | IL |
H99182 | (02) | IL |