Johnson, Andrew Robert

Johnson, Andrew Robert is an individual health care provider with primary practice located at 4218 Lincolnshire Dr , Mount Vernon IL 62864-2156. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Johnson, Andrew Robert can be contacted via phone (618) 242-8480.

Contact Information

Primary practice address
4218 Lincolnshire Dr Mount Vernon IL 62864-2156
Phone: (618) 242-8480
Fax: (618) 242-8499
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 28808 Mississippi
Allopathic & Osteopathic Physicians / Surgery 208600000X 036121708 Illinois

Profile Details

NPI number 1164418943
LBN Legal business name Johnson, Andrew Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 27th, 2005
Last updated Oct 11th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164418943 NPPES
Illinois MEDICAID 036121708

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