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Individual

DR. MATTHEW TODD JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
344 VICTORY DR, PARK FOREST, IL 60466-2003
(708) 481-0100
Mailing address
111 ACACIA DR, UNIT 515, INDIAN HEAD PARK, IL 60525-4404
(708) 481-0100

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036099289
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01634105
BLUE CROSS PROVIDER #
IL
05
036099289
IL
Enumeration date
11/15/2007
Last updated
05/04/2018
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