MEDICARE: CATHERINE JOHNSON MD FACEP, ABOM, MSCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	01056490	IN
2	207P00000X	Emergency Medicine Physician	036107532	IL
3	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	36107532	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083609218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE JOHNSON MD FACEP, ABOM, MSCP

Provider Business Mailing Address
First Line	:	256 HOLMES AVE
Second Line	:
City	:	CLARENDON HILLS
State	:	IL
Zip	:	60514-1444
Country	:	US
Telephone Number	:	630-908-7036
Fax Number	:	630-908-7037

Provider Business Practice Location Address
First Line	:	23 WALKER AVE
Second Line	:
City	:	CLARENDON HILLS
State	:	IL
Zip	:	60514-1338
Country	:	US
Telephone Number	:	312-343-4342
Fax Number	:	312-736-9556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/14/2025

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