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General NPI Number Information
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NPI Number | 1366562043
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Entity Type | Organization
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Legal Business Name | CMJ MEDICAL ENTERPRISES LTD
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 8507 S STONY ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60617-2247
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Country | US
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Telephone | 773-978-1400
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Fax | 773-978-4389
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Provider Business Mailing Address
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Address Line | 8507 S STONY ISLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60617-2247
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Country | US
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Telephone | 773-978-1400
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Fax | 773-978-4389
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Authorized Official
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Title or Position | MEDICAL DIRECTOR, PRESIDENT
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Name | CLAUDIA JOHNSON
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Credential | MD
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Telephone | 773-978-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036057668
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License Number State | ID
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