Mcconnie, Randolph

Mcconnie, Randolph is an individual health care provider with primary practice located at 17850 Kedzie Ave 3200, Hazel Crest IL 60429-2058. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gastroenterology, Allopathic & Osteopathic Physicians / Pediatric Gastroenterology. Allopathic & Osteopathic Physicians / Pediatric Gastroenterology is his primary health care specialty. Mcconnie, Randolph can be contacted via phone (708) 798-8112.

Contact Information

Primary practice address
17850 Kedzie Ave 3200 Hazel Crest IL 60429-2058
Phone: (708) 798-8112
Fax: (708) 798-9016
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 036079072 Illinois
Allopathic & Osteopathic Physicians / Pediatric Gastroenterology 2080P0206X 036-079072 Illinois

Profile Details

NPI number 1770580706
LBN Legal business name Mcconnie, Randolph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2005
Last updated Aug 13th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770580706 NPPES
Illinois MEDICAID 036079072

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