Individual
BRADLEY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5875 E RIVERSIDE BLVD, ROCKFORD, IL 61114-4937
(815) 398-9491
(815) 381-7498
Mailing address
BOX 78534, MILWAUKEE, WI 53278-8534
(815) 398-9491
(815) 381-7498
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036075034
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036075034
—
IL
Enumeration date
03/30/2006
Last updated
02/05/2020
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