Individual
DR. KASEY BRYAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Mailing address
3249 OAK PARK AVE, BERWYN, IL 60402-0715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.082751
IL
207W00000X
Ophthalmology Physician
Primary
125.082751
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/14/2022
Last updated
04/11/2024
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