Basic Information
| Provider Information | |||||||||
| NPI: | 1902337918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 E HURON ST STE 5-704 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950061 | ||||||||
| FaxNumber: | 3126959013 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 E HURON ST STE 5-704 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950061 | ||||||||
| FaxNumber: | 3126959013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 125.070042 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207R00000X | 125070042 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207L00000X | 036159282 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.