Provider Demographics
NPI:1154396521
Name:JOHNSON, THOMAS WESLEY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WESLEY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5573
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:STE 310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-6782
Practice Address - Fax:502-899-6783
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY381022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50029990OtherPASSPORT- NORTON NEUROLOGY SERVICES
KY64069156Medicaid
IN200378110Medicaid
KY000000672012OtherANTHEM- NORTON NEUROLOGY SERVICES
KYP00889604OtherRAILROAD MEDICARE
KY000052153YOtherHUMANA- NORTON NEUROLOGY SERVICES
KYG44338Medicare UPIN
KYP4000396521Medicare PIN
KY50029990OtherPASSPORT- NORTON NEUROLOGY SERVICES