| Doctor Name: | JEFFREY JOHNSON |
| NPI Number: | 1063886935 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 085.005650 |
| Business Practice Address: | 1365 Wiley Rd Ste 153 Schaumburg, IL - 601734382 |
| Business Phone Number: | 8475194701 |
| Business Fax Number: | |
| Mailing Address: | 2447 Momentum Pl, Ste 153 CHICAGO |
| State: | IL |
| Postal Code: | 606895325 |
| Phone Number: | 8475194701 |
| Fax Number: | 8475194707 |
| NPI Enumeration Date: | 11/16/2015 |
| NPI Last Update Date: | 03/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085.005650 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |