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General NPI Number Information
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NPI Number | 1861611816
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Entity Type | Individual
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Provider Name | RANDON CHARLES JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1431 N WESTERN AVE #310
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City | CHICAGO
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State | IL
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Zip | 60622-1797
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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 | 365 N JEFFERSON ST APT 3505
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City | CHICAGO
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State | IL
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Zip | 60661-1600
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Country | US
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Telephone | 312-622-6086
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 25IA12837800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 24126
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2935
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License Number State | WI
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Taxonomy #4
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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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