NPI 1609523240

Theodore Johnson, MD

Practitioner General Practice Physician Great Lakes, IL

Practice location

Address: 3410 Illinois St, Great Lakes, IL 60088-3120
Phone: (224) 610-8553
Mailing address: 220 Hovey Rd, Pensacola, FL 32508-1044

Registered specialties (2)

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 0101279593 (VA)

Other General Practice providers in Illinois →

Military Health Care Provider

Other Service Providers Taxonomy 171000000X Licence 0101279593 (VA)

Other Military Health Care Provider providers in Illinois →

Registry record

NPI: 1609523240
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Mar 2022
Record last updated: 9 Jul 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.