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General NPI Number Information
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NPI Number | 1346529724
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Entity Type | Organization
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Legal Business Name | CONNERY PEDIATRICS, LLC
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 170 BRACKEN PKWY
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City | HOBART
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State | IN
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Zip | 46342-6789
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Country | US
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Telephone | 219-940-9605
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Fax | 219-940-9606
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Provider Business Mailing Address
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Address Line | PO BOX 1076
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City | CROWN POINT
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State | IN
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Zip | 46308-1076
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Country | US
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Telephone | 219-662-3931
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Fax | 219-663-6359
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Authorized Official
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Title or Position | OWNER
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Name | MARC A CONNERY
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Credential | MD
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Telephone | 219-942-7156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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