MEDICARE: MR. BYRON M. JOHNSON APN-CRNA

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	367500000X	Certified Registered Nurse Anesthetist	209024135	IL
2	363LF0000X	Family Nurse Practitioner	ARNP9343184	FL
3	367500000X	Certified Registered Nurse Anesthetist	209023906	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	:	1902296080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BYRON M. JOHNSON APN-CRNA

Provider Business Mailing Address
First Line	:	251 E HURON ST STE 5-704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-695-0061
Fax Number	:	312-695-9013

Provider Business Practice Location Address
First Line	:	251 E HURON ST STE 5-704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-695-0061
Fax Number	:	312-695-9013

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

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	01/15/2026

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