Basic Information
| Provider Information | |||||||||
| NPI: | 1730290198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 PLAINFIELD RD | ||||||||
| Address2: | STE., B | ||||||||
| City: | WILLOWBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605277600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302865300 | ||||||||
| FaxNumber: | 6309861096 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 PLAINFIELD RD | ||||||||
| Address2: | STE., B | ||||||||
| City: | WILLOWBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605277600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302865300 | ||||||||
| FaxNumber: | 6309861096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | 036089321 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.