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THEODORE JOHNSON MD
NPI 1609523240
General Practice in Great Lakes, IL

Active since March 03, 2022
3410 ILLINOIS ST, GREAT LAKES, IL 60088(224) 610-8553 Get Directions Write a Review

NPPES record last updated: July 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 9, 2025, Aug 22, 2023, Mar 3, 2022 (3 updates tracked since 2022).

About Theodore Johnson Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THEODORE JOHNSON MD (NPI 1609523240) is an individual general practice provider in Great Lakes, Illinois, licensed in Virginia (0101279593) and active in the NPI registry since March 2022.

NPPES Registry Identity

NPI1609523240
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameTHEODORE JOHNSONCredential: MD
Location Address3410 ILLINOIS STGreat Lakes, IL 60088-3120
Mailing Address220 Hovey RdPensacola, FL 32508-1044
Phone(224) 610-8553
Sole ProprietorNo
Enumeration DateMarch 3, 2022
Last NPPES UpdateJuly 9, 20253 updates tracked since enumeration
NPPES CertifiedJuly 9, 2025
✔ NPI 1609523240 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in VA · 0101279593
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedMilitary Health Care ProviderTaxonomy 171000000X · License 0101279593 (VA)
3410 ILLINOIS ST, Great Lakes, IL 60088
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Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADAM ROBERT DZIEDZIC P.A.-C
Physician Assistant
3410 ILLINOIS ST
GREAT LAKES, IL 60088
Lake County (224) 610-8553
EVAN FUCHS
General Practice
3410 ILLINOIS ST
GREAT LAKES, IL 60088
Lake County (847) 340-0495
MAXWELL ROONEY
Physician Assistant
3410 ILLINOIS ST
GREAT LAKES, IL 60088
Lake County (847) 688-2469
HERCHEL MANGUNE PTA
Physical Therapy Assistant
3410 ILLINOIS ST
GREAT LAKES, IL 60088
Lake County (224) 610-8553
KELSIE LYNN HAMMAC
Specialist/Technologist, Other
3410 ILLINOIS ST
GREAT LAKES, IL 60088
Lake County (847) 688-1900
BRIGHAM TYLER WELLS PA-C
Physician Assistant
3410 ILLINOIS ST
NORTH CHICAGO, IL 60088
Lake County (224) 610-3886

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Johnson's NPI number?

The NPI number for Theodore Johnson is 1609523240. It was assigned to this individual provider in the NPPES registry on March 3, 2022.

Where is Theodore Johnson located?

Theodore Johnson practices at 3410 Illinois St, Great Lakes, IL 60088. The listed phone number is (224) 610-8553.

What is Theodore Johnson's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Theodore Johnson was last updated on July 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.