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Individual

CHARLES BRADFORD JOHNSTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1102 CHICAGO AVE, OAK PARK, IL 60302-1804
(708) 948-7772
(708) 948-7773
Mailing address
1102 CHICAGO AVE, OAK PARK, IL 60302-1804
(708) 948-7772
(708) 948-7773

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036078749
IL
208000000X
Pediatrics Physician
036078749
IL

Other

Enumeration date
10/12/2006
Last updated
12/13/2010
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