1295669034 NPI number — MR. QUAISHON NAJEE JOHNSON SR.

Table of content: MR. QUAISHON NAJEE JOHNSON SR. (NPI 1295669034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295669034 NPI number — MR. QUAISHON NAJEE JOHNSON SR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
QUAISHON
Provider Middle Name:
NAJEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295669034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5652 S MARSHFIELD AVE APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60636-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-520-1478
Provider Business Mailing Address Fax Number:
773-520-1478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11560 S KEDZIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRIONETTE PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60803-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-974-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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