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General NPI Number Information
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NPI Number | 1376629626
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Entity Type | Organization
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Legal Business Name | LAWRENCE L. JOHNSON, M.D., S.C.
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Dates
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Enumeration Date | 10/30/2006
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 351 DELNOR DR STE. 400
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City | GENEVA
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State | IL
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Zip | 60134
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Country | US
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Telephone | 630-232-2885
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Fax | 630-232-9936
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Provider Business Mailing Address
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Address Line | 351 DELNOR DR STE. 400
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City | GENEVA
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State | IL
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Zip | 60134
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Country | US
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Telephone | 630-232-2885
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Fax | 630-232-9936
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE L. JOHNSON
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Credential | M.D.
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Telephone | 630-232-2885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036052717
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License Number State | IL
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