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NPI Code Detail

MEDICARE: CHERYL KAREN CONNER MD

MEDICARE: CHERYL KAREN CONNER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036.128627IL

General Provider Information

NPI Number : 1093980864
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL KAREN CONNER MD
Provider Business Mailing Address
First Line : 1333 S CALIFORNIA AVE APT 3F
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1668
Country : US
Telephone Number : 301-717-4286
Fax Number :
Provider Business Practice Location Address
First Line : 1653 W CONGRESS PKWY
Second Line : 301 JONES
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-6639
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2008
Last Update Date : 05/01/2012

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