Individual
DR. MATTHEW CHARLES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2240 GATEWAY DR, SYCAMORE, IL 60178-3103
(815) 756-7136
Mailing address
2240 GATEWAY DR, SYCAMORE, IL 60178-3103
(815) 756-7136
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036132348
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036132348
—
IL
Enumeration date
06/09/2009
Last updated
09/17/2015
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