Johnson, Carl R

Johnson, Carl R is an sole proprietor health care provider with primary practice located at 500 Health Center Dr Suite 104, Mattoon IL 61938-9258. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Johnson, Carl R can be contacted via phone (217) 258-4080.

Contact Information

Primary practice address
500 Health Center Dr Suite 104 Mattoon IL 61938-9258
Phone: (217) 258-4080
Fax: (217) 258-4084
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036057126 Illinois

Profile Details

NPI number 1275525701
LBN Legal business name Johnson, Carl R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 19th, 2005
Last updated Jan 27th, 2015 - about 10 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 1275525701 NPPES
Illinois MEDICAID 036057126
Illinois Other 170490
Illinois Other 0001520105

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