Individual
SAM JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7435 W TALCOTT AVE, CHICAGO, IL 60631-3707
(773) 792-7921
Mailing address
7435 W TALCOTT AVE, CHICAGO, IL 60631-3707
(773) 792-7921
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
125.084222
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2024
Last updated
06/13/2024
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