Healthcare Provider Details

I. General information

NPI: 1689674608
Provider Name (Legal Business Name): MARC CONNERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DIXIE HWY
CHICAGO HEIGHTS IL
60411-1741
US

IV. Provider business mailing address

PO BOX 1076
CROWN POINT IN
46308-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-7156
  • Fax:
Mailing address:
  • Phone: 219-662-3931
  • Fax: 219-663-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.098822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: