Healthcare Provider Details

I. General information

NPI: 1790148575
Provider Name (Legal Business Name): CONNOR ANDREW MORTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST GALTER 3-150
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

809 S BISHOP ST APT BSMT
CHICAGO IL
60607-4051
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-9404
  • Fax:
Mailing address:
  • Phone: 802-922-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME156448
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME156448
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.069449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: