MEDICARE: DR. HEATHER ANNE BOUMA-JOHNSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VC0300X	Complex Family Planning Physician	036170327	IL

General Provider Information

NPI Number	:	1376172049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER ANNE BOUMA-JOHNSTON MD

Provider Business Mailing Address
First Line	:	1620 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3801
Country	:	US
Telephone Number	:	312-327-8850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3801
Country	:	US
Telephone Number	:	312-327-8850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2020
Last Update Date	:	09/17/2024

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