Individual
MR. DAVID ROBERT JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NAVY IDC
Contact information
Practice address
3001A SIXTH STREET, NAVAL HOSPITAL FISHER CLINIC, GREAT LAKES, IL 60088
(847) 688-2469
(847) 688-2512
Mailing address
1130 BOB OFARRELL LN, BEACH PARK, IL 60099-4512
(847) 263-8867
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/08/2006
Last updated
06/06/2008
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