Provider Demographics
NPI:1992805782
Name:JOHNSON, CLAUDIA (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 S STONY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2247
Mailing Address - Country:US
Mailing Address - Phone:773-978-1400
Mailing Address - Fax:773-978-4389
Practice Address - Street 1:8507 S STONY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2247
Practice Address - Country:US
Practice Address - Phone:773-978-1400
Practice Address - Fax:773-978-4389
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057668207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC25460Medicare UPIN