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General NPI Number Information
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NPI Number | 1740393495
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Entity Type | Individual
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Provider Name | MARCIA E JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 707 LAKE COOK ROAD SUITE #280
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City | DEERFIELD
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State | IL
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Zip | 60015-4909
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Country | US
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Telephone | 847-480-0004
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Fax | 847-480-8707
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Provider Business Mailing Address
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Address Line | 707 LAKE COOK RD SUITE #280
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City | DEERFIELD
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State | IL
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Zip | 60015-5613
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Country | US
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Telephone | 847-480-0004
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Fax | 847-480-8707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 036-093410
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License Number State | IL
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