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General NPI Number Information
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NPI Number | 1225357221
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Entity Type | Organization
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Legal Business Name | RANDON JOHNSON, LLC
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Dates
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Enumeration Date | 05/31/2010
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Last Update Date | 05/31/2010
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Provider Practice Location Address
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Address Line | 1431 N WESTERN AVE STE 310
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City | CHICAGO
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State | IL
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Zip | 60622-1774
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Country | US
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Telephone | 773-235-1900
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Fax | 773-235-2999
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Provider Business Mailing Address
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Address Line | 1431 N WESTERN AVE STE 310
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City | CHICAGO
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State | IL
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Zip | 60622-1774
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Country | US
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Telephone | 773-235-1900
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Fax | 773-235-2999
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDON JOHNSON
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Credential | M.D.
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Telephone | 312-622-6086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036.120944
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License Number State | IL
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