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NPI Code Detail

MEDICARE: JOHN CONROY P.A.

MEDICARE: JOHN CONROY P.A.
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
1363AM0700XMedical Physician AssistantIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101618781OTHERILBC/BS

General Provider Information

NPI Number : 1780669440
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN CONROY P.A.
Provider Business Mailing Address
First Line : 909 E PALATINE RD
Second Line :
City : PALATINE
State : IL
Zip : 60074-5551
Country : US
Telephone Number : 847-776-1400
Fax Number : 847-776-1424
Provider Business Practice Location Address
First Line : 909 E PALATINE RD
Second Line :
City : PALATINE
State : IL
Zip : 60074-5551
Country : US
Telephone Number : 847-776-1400
Fax Number : 847-776-1424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 07/08/2007

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