Provider Demographics
NPI:1770626269
Name:CONROY, JOHN C (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:CONROY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7009
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-7009
Mailing Address - Country:US
Mailing Address - Phone:630-312-7865
Mailing Address - Fax:
Practice Address - Street 1:908 N ELM ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3635
Practice Address - Country:US
Practice Address - Phone:630-323-1558
Practice Address - Fax:630-969-1095
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN4921OtherRR MEDICARE
CN4921OtherRR MEDICARE
IL399690Medicare PIN
ILI71201Medicare UPIN