Individual
ANDREW ROBERT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4218 LINCOLNSHIRE DR, MOUNT VERNON, IL 62864-2156
(618) 242-8480
(618) 242-8499
Mailing address
4218 LINCOLNSHIRE DR, PO BOX 968, MOUNT VERNON, IL 62864-2156
(618) 242-8480
(618) 242-8499
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036121708
IL
208600000X
Surgery Physician
28808
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036121708
—
IL
Enumeration date
09/27/2005
Last updated
10/11/2022
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