Healthcare Provider Details

I. General information

NPI: 1235889478
Provider Name (Legal Business Name): BRIA CHERISE JOHNSON MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E SUPERIOR ST
CHICAGO IL
60611-4494
US

IV. Provider business mailing address

420 E SUPERIOR ST DEPARTMENT OF UROGYNECOLOGY
CHICAGO IL
60611-4494
US

V. Phone/Fax

Practice location:
  • Phone: 312-649-3165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036.181087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: