Individual
DR. RYAN MATTHEW 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
(804) 304-8541
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(804) 304-8541
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
125.078630
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2021
Last updated
07/08/2021
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