Basic Information
| Provider Information | |||||||||
| NPI: | 1578581716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2357 SEQUOIA DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605066222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308596800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 W FABYAN PKWY | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605101572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308792110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036-070736 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 2083X0100X | 036-070736 | IL | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036070736 | 05 | IL | MEDICAID |