Individual
DR. VINCENT L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 RANDALL RD, GENEVA, IL 60134-4200
(630) 933-4700
(630) 933-4427
Mailing address
300 RANDALL RD, GENEVA, IL 60134-4200
(630) 933-4700
(630) 933-4427
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
036069759
IL
208000000X
Pediatrics Physician
036-096759
IL
208M00000X
Hospitalist Physician
Primary
036096759
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036096759
—
IL
01
—
206147
MEDICARE GROUP NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
01
—
P00656803
MEDICARE RAILROAD
IL
Enumeration date
09/09/2005
Last updated
07/19/2013
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