MEDICARE: DR. BENJAMIN E JOHNSON M.D.

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	208600000X	Surgery Physician	036149861	IL

General Provider Information

NPI Number	:	1851731590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN E JOHNSON M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE STE 213
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3532
Country	:	US
Telephone Number	:	773-293-4001
Fax Number	:	773-293-3203

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 213
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3532
Country	:	US
Telephone Number	:	773-293-4001
Fax Number	:	773-293-3203

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	04/08/2021

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Directions to “ DR. BENJAMIN E JOHNSON M.D.” Practice Location

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