Individual
AMMON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6831 S DANTE AVE, CHICAGO, IL 60637-4830
(312) 320-9475
Mailing address
6831 S DANTE AVE, CHICAGO, IL 60637-4830
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
12/28/2015
Last updated
12/28/2015
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