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Individual

DR. CARL WINSTON JOHNSON II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6703 W 159TH STREET, SUITE 110, TINLEY PARK, IL 60477
(708) 331-1122
(708) 331-5987
Mailing address
6703 W 159TH STREET, SUITE 110, TINLEY PARK, IL 60477
(708) 331-1122
(708) 331-5987

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
36107266
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
36107266
IL
01
363950/L93169
MEDICARE GROUP/PROVIDER
IL
Enumeration date
07/07/2005
Last updated
09/05/2018
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