Individual
KEVIN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5841 S DAMEN AVE, CHICAGO, IL 60636-1507
(312) 874-2142
Mailing address
5841 S DAMEN AVE, CHICAGO, IL 60636-1507
(312) 874-2142
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
—
Other
Enumeration date
03/15/2022
Last updated
03/15/2022
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