Healthcare Provider Details

I. General information

NPI: 1386897718
Provider Name (Legal Business Name): LARON NEAL JOHNSON M.D., M.P.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E. HURON ST., STE. 5-704 NORTHWESTERN UNIVERSITY DEPT. OF ANESTHESIOLOGY
CHICAGO IL
60611
US

IV. Provider business mailing address

40 E 9TH ST UNIT 508
CHICAGO IL
60605-2138
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-8349
  • Fax: 312-926-8341
Mailing address:
  • Phone: 312-913-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036119772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: