Individual
SARA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-9100
Mailing address
212 N RIDGELAND AVE, OAK PARK, IL 60302-2323
(708) 383-0568
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-107859
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107859
—
IL
Enumeration date
09/20/2006
Last updated
01/09/2009
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