Provider Demographics
NPI:1144247784
Name:JOHNSON, CATHERINE (DO)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1018
Mailing Address - Country:US
Mailing Address - Phone:847-718-3302
Mailing Address - Fax:847-996-9109
Practice Address - Street 1:100 NW POINT BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1018
Practice Address - Country:US
Practice Address - Phone:847-718-3302
Practice Address - Fax:847-996-9109
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL083123207R00000X
CA20A18588207R00000X
CODR.0066672207R00000X
KY04777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083123Medicaid
IL036083123Medicaid
K02597Medicare PIN
K20609Medicare PIN
F41332Medicare UPIN