Provider Demographics
NPI:1811011760
Name:CONROE, HENRY G (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:G
Last Name:CONROE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25 EAST WASHINGTON ST.
Mailing Address - Street 2:SUITE #1006
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-782-2335
Mailing Address - Fax:847-866-7792
Practice Address - Street 1:25 EAST WASHINGTON
Practice Address - Street 2:SUITE #1006
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-782-2335
Practice Address - Fax:847-866-7792
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360489442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL484980Medicare ID - Type Unspecified