Healthcare Provider Details

I. General information

NPI: 1811359649
Provider Name (Legal Business Name): KEVIN CONLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 ELLINWOOD AVE
DES PLAINES IL
60016-4553
US

IV. Provider business mailing address

1535 ELLINWOOD AVE
DES PLAINES IL
60016-4553
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-7846
  • Fax: 847-795-9472
Mailing address:
  • Phone: 847-866-7846
  • Fax: 847-795-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036148701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: