Individual
DR. MARK M. CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2913 N COMMONWEALTH AVE, 5TH FLOOR, CHICAGO, IL 60657-6211
(773) 472-3427
(773) 472-8561
Mailing address
PO BOX 597995, CHICAGO, IL 60659-7995
(773) 472-3427
(773) 472-8561
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
036063941
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001618161
BCBS OF IL
IL
05
—
036063941
—
IL
01
—
P00261094
MEDICARE RAILROAD PART B
IL
Enumeration date
05/19/2006
Last updated
03/30/2021
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