Healthcare Provider Details

I. General information

NPI: 1811008816
Provider Name (Legal Business Name): CONRAD L. EPTING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 73
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 73
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax: 312-227-9640
Mailing address:
  • Phone: 312-227-4000
  • Fax: 312-227-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036119190
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036119190
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: