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NPI Code Detail

MEDICARE: BRADLEY L JOHNSON MD

MEDICARE: BRADLEY L JOHNSON MD
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
1207L00000XAnesthesiology Physician036075034IL

Other Identifiers

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

General Provider Information

NPI Number : 1962463935
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY L JOHNSON MD
Provider Business Mailing Address
First Line : BOX 78534
Second Line :
City : MILWAUKEE
State : WI
Zip : 53278-8534
Country : US
Telephone Number : 815-398-9491
Fax Number : 815-381-7498
Provider Business Practice Location Address
First Line : 5875 E RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-4937
Country : US
Telephone Number : 815-398-9491
Fax Number : 815-381-7498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2006
Last Update Date : 02/05/2020

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Directions to “ BRADLEY L JOHNSON MD” Practice Location

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