Doctor Name: | DR. GERALD TIMOTHY JOHNSON |
NPI Number: | 1083637615 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 5101 Willow Springs Rd La Grange, IL - 605252600 |
Business Phone Number: | 7083521200 |
Business Fax Number: | |
Mailing Address: | 352 Glenwood Dr Apt 303, BLOOMINGDALE |
State: | IL |
Postal Code: | 601083253 |
Phone Number: | 6303076937 |
Fax Number: | |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |