Individual
TIMOTHY W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 472-7317
(317) 870-0499
Mailing address
5446 RELIABLE PKWY, CHICAGO, IL 60686-0001
(317) 472-7317
(317) 870-0499
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001198
IN
Other
Enumeration date
08/26/2010
Last updated
08/26/2010
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