Provider Demographics
NPI:1386897718
Name:JOHNSON, LARON NEAL (MD, MPP)
Entity type:Individual
Prefix:DR
First Name:LARON
Middle Name:NEAL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD, MPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E 9TH ST
Mailing Address - Street 2:UNIT 508
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2138
Mailing Address - Country:US
Mailing Address - Phone:312-913-0347
Mailing Address - Fax:
Practice Address - Street 1:251 E. HURON ST., STE. 5-704
Practice Address - Street 2:NORTHWESTERN UNIVERSITY DEPT. OF ANESTHESIOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-8349
Practice Address - Fax:312-926-8341
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119772207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology