Healthcare Provider Details

I. General information

NPI: 1033536412
Provider Name (Legal Business Name): VERONICA RENEE JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 2150
CHICAGO IL
60611-3370
US

IV. Provider business mailing address

259 E ERIE ST STE 2150
CHICAGO IL
60611-3370
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-3627
  • Fax: 312-926-3858
Mailing address:
  • Phone: 312-926-3627
  • Fax: 312-926-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR7491
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036153380
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: