Individual
DR. JOHNNY DAN PARKER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
8601 S COTTAGE GROVE AVE, CHICAGO, IL 60619-6107
(773) 783-7599
(773) 783-7698
Mailing address
8601 S COTTAGE GROVE AVE, CHICAGO, IL 60619-6107
(773) 783-7599
(773) 783-7698
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60001157
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/26/2005
Last updated
07/08/2007
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