Johnson, Carl Winston

Johnson, Carl Winston is an individual health care provider with primary practice located at 6703 W 159Th Street Suite 110, Tinley Park IL 60477. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Johnson, Carl Winston can be contacted via phone (708) 331-1122.

Contact Information

Primary practice address
6703 W 159Th Street Suite 110 Tinley Park IL 60477
Phone: (708) 331-1122
Fax: (708) 331-5987
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 36107266 Illinois

Profile Details

NPI number 1467450122
LBN Legal business name Johnson, Carl Winston
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Sep 5th, 2018 - about 8 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 1467450122 NPPES
Illinois MEDICAID 36107266
Illinois Other 363950/L93169

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