Provider Demographics
NPI:1083609218
Name:JOHNSON, CATHERINE (MD FACEP, ABOM, MSCP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MD FACEP, ABOM, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1444
Mailing Address - Country:US
Mailing Address - Phone:630-908-7036
Mailing Address - Fax:630-908-7037
Practice Address - Street 1:23 WALKER AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1338
Practice Address - Country:US
Practice Address - Phone:312-343-4342
Practice Address - Fax:312-736-9556
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056490207P00000X
IL036107532207P00000X
IL361075322083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200430170Medicaid
IN496650 JJJMedicare ID - Type Unspecified
IN200430170Medicaid