Individual provider · Type 1 NPI

Theodore Johnson, MD

General Practice Physician · Great Lakes, IL

NPI number 1609523240 Active

Practice location

3410 Illinois St
Great Lakes, IL 60088-3120

Call (224) 610-8553 Map

Mailing address

220 Hovey Rd
Pensacola, FL 32508-1044

Specialties and licenses

TaxonomyCodeLicense
Military Health Care Provider 171000000X0101279593 (VA)
General Practice Physician Primary 208D00000X0101279593 (VA)

General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

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About NPI 1609523240

Theodore Johnson, MD's National Provider Identifier is 1609523240, issued on Mar 3, 2022. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in Great Lakes, IL. The record was last updated on Jul 9, 2025.