Healthcare Provider Details

I. General information

NPI: 1881089662
Provider Name (Legal Business Name): LAURA JEAN JOHNSON O'LAUGHLIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 N KEDZIE BLVD
CHICAGO IL
60647
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-2700
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036146357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: