Healthcare Provider Details

I. General information

NPI: 1154024347
Provider Name (Legal Business Name): CHRISTEN DEANNA JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 W LAKE ST
CHICAGO IL
60644-2343
US

IV. Provider business mailing address

5461 W LAKE ST
CHICAGO IL
60644-2343
US

V. Phone/Fax

Practice location:
  • Phone: 773-295-3500
  • Fax:
Mailing address:
  • Phone: 773-295-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.181145
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: