MEDICARE: CONNECTIONS MEDICAL GROUP ASSOCIATES LLC

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
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	036126914	IL
2	2084P0800X	Psychiatry Physician	036111615	IL
3	2084P0804X	Child & Adolescent Psychiatry Physician	036111615	IL

General Provider Information

NPI Number	:	1548697618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTIONS MEDICAL GROUP ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2081 CALISTOGA DR STE 2S
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-4833
Country	:	US
Telephone Number	:	815-418-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2081 CALISTOGA DR STE 2S
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-4833
Country	:	US
Telephone Number	:	815-418-6070
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. SEMONE WEST
Credential	:	MD
Telephone Number	:	312-208-9741

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	05/19/2023

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