Healthcare Provider Details

I. General information

NPI: 1356086607
Provider Name (Legal Business Name): TOBIN JOHNSON CHEMPLAVIL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 N ALPINE RD
LOVES PARK IL
61111-3107
US

IV. Provider business mailing address

5427 SILK OAK DR
NAPERVILLE IL
60564-5005
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-3397
  • Fax: 815-971-9795
Mailing address:
  • Phone: 630-303-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number105443
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: