Individual
SHANNON RAE CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(866) 600-2273
Mailing address
500 THATCHER AVE, RIVER FOREST, IL 60305-1625
(708) 557-0591
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036.137920
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2012
Last updated
11/09/2015
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