Individual
EBONY NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4742 CAL SAG RD, CRESTWOOD, IL 60418
(708) 915-2727
Mailing address
27702 NETWORK PL, CHICAGO, IL 60673-1277
(708) 862-7674
(708) 862-1781
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03612077
IL
Other
Enumeration date
09/29/2006
Last updated
07/23/2018
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