Johnson, Bradley L
Johnson, Bradley L is an individual health care provider with primary practice located at 5875 E Riverside Blvd , Rockford IL 61114-4937. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Johnson, Bradley L can be contacted via phone (815) 398-9491.Contact Information
Primary practice address
5875 E Riverside Blvd
Rockford IL 61114-4937
Phone: (815) 398-9491
Fax: (815) 381-7498
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 036075034 | Illinois |
Profile Details
| NPI number | 1962463935 |
|---|---|
| LBN Legal business name | Johnson, Bradley L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 30th, 2006 |
| Last updated | Feb 5th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962463935 | NPPES |
| Illinois | MEDICAID | 036075034 |
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