MEDICARE: RANDON CHARLES 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	207X00000X	Orthopaedic Surgery Physician	25IA12837800	NJ
2	207X00000X	Orthopaedic Surgery Physician	24126	NE
3	207X00000X	Orthopaedic Surgery Physician	2935	WI
4	207X00000X	Orthopaedic Surgery Physician	036.120944	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	:	1861611816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDON CHARLES JOHNSON M.D.

Provider Business Mailing Address
First Line	:	365 N JEFFERSON ST APT 3505
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1600
Country	:	US
Telephone Number	:	312-622-6086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1431 N WESTERN AVE
Second Line	:	#310
City	:	CHICAGO
State	:	IL
Zip	:	60622-1797
Country	:	US
Telephone Number	:	773-235-1900
Fax Number	:	773-235-2999

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	12/05/2025

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Directions to “ RANDON CHARLES JOHNSON M.D.” Practice Location

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