Individual
ISHA L MCCONKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2 SAINT ANTHONYS WAY STE 205, ALTON, IL 62002-4569
(618) 463-2222
(618) 463-5004
Mailing address
2 SAINT ANTHONYS WAY STE 205, ALTON, IL 62002-4569
(618) 463-2222
(618) 463-5004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036158038
IL
207Q00000X
Family Medicine Physician
34.011181
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115016
—
OH
01
—
376013958
IRS
IL
Enumeration date
05/12/2011
Last updated
03/06/2025
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