Individual
MATTHEW DAVID JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
720 N BOND ST, SPRINGFIELD, IL 62702-4952
(217) 545-8000
(217) 545-6544
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036-139255
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036139255
—
IL
Enumeration date
07/15/2009
Last updated
09/25/2024
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