Healthcare Provider Details

I. General information

NPI: 1346529724
Provider Name (Legal Business Name): CONNERY PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 BRACKEN PKWY
HOBART IN
46342-6789
US

IV. Provider business mailing address

PO BOX 1076
CROWN POINT IN
46308-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-940-9605
  • Fax: 219-940-9606
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 Number
License Number State

VIII. Authorized Official

Name: MARC A CONNERY
Title or Position: OWNER
Credential: MD
Phone: 219-942-7156