Johnson, Matthew Todd

Johnson, Matthew Todd is an sole proprietor health care provider with primary practice located at 344 Victory Dr , Park Forest IL 60466-2003. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Johnson, Matthew Todd can be contacted via phone (708) 481-0100.

Contact Information

Primary practice address
344 Victory Dr Park Forest IL 60466-2003
Phone: (708) 481-0100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036099289 Illinois

Profile Details

NPI number 1568643864
LBN Legal business name Johnson, Matthew Todd
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 15th, 2007
Last updated May 4th, 2018 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568643864 NPPES
Illinois MEDICAID 036099289
Illinois Other 01634105

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