Provider Demographics
NPI:1023304771
Name:JOHNSON, KIILA NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:KIILA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10701 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7282
Mailing Address - Country:US
Mailing Address - Phone:703-486-6169
Mailing Address - Fax:703-257-3117
Practice Address - Street 1:250 E SUPERIOR ST
Practice Address - Street 2:#5-2177
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059099207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology