Provider Demographics
NPI:1437545746
Name:MCCONN, TIMOTHY PATRIC (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRIC
Last Name:MCCONN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:MCCONN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1455 E GOLF RD
Mailing Address - Street 2:STE 110
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1455 E GOLF RD STE 110
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1253
Practice Address - Country:US
Practice Address - Phone:847-390-7666
Practice Address - Fax:847-390-9345
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005779213ES0103X
WI1121213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty