Individual
MR. WENDELL WALTER JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4735 N BEACON, #109, CHICAGO, IL 60640
(773) 293-4575
Mailing address
12626 S ELIZABETH ST, CALUMET PARK, IL 60827-6111
(708) 396-8923
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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