Theodore Johnson, MD
NPI #1609523240 in Great Lakes, Illinois
Provider Information
- NPI Number
- 1609523240
- Entity Type
- Individual
- Name
- Theodore Johnson, MD
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- General Practice
- Credential
- MD
- Enumeration Date
- Mar 3, 2022
- Last Updated
- Jul 9, 2025
Practice Location
- Address
- 3410 ILLINOIS ST
- City
- Great Lakes
- State
- Illinois
- ZIP Code
- 60088-3120
- Phone
- (224) 610-8553
Specialties & Taxonomy Codes
| Specialty |
|---|
| Military Health Care Provider |
| General Practice |
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