DR. MARK M. CONNOLLY (NPI# 1033162839) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033162839 |
| Entity Type | Individual |
| Full Name | DR. MARK M. CONNOLLY |
| Credential | M.D. |
| Practice Address |
2913 N Commonwealth Ave 5th Floor Chicago IL 60657-6211 |
| Mailing Address |
Po Box 597995 Chicago IL 60659-7995 |
| Practice Telephone | 7734723427 |
| Practice Fax Number | 7734728561 |
| Mailing Telephone | 7734723427 |
| Mailing Fax Number | 7734728561 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-12-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086X0206X |
Surgery Specialization: Surgical Oncology |
IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS OF IL | 0001618161 | 01 |
| IL | MEDICARE RAILROAD PART B | P00261094 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730361015 | Mark Allen Connolly | Dentist | 1958 N Jackson St, Tullahoma, TN 37388-2204 | 2007-11-29 |
| 1053396259 | Mark L Connolly | Dentist | 411 High St, Medford, MA 02155-3610 | 2005-12-09 |
| 1326010612 | Mark William Connolly | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 703 Main St, Department of Surgery, Paterson, NJ 07503-2621 | 2006-02-02 |
| Street Address |
2913 N COMMONWEALTH AVE 5TH FLOOR |
| City | CHICAGO |
| State | IL |
| Zip Code | 60657-6211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235650805 | Sumathi Vijaya Rangan | Internal Medicine | 2913 N Commonwealth Ave, Chicago, IL 60657-6211 | 2017-07-04 |
| 1861912297 | Luis Jose Galindez Lopez | Internal Medicine | 2913 N Commonwealth Ave, Chicago, IL 60657-6211 | 2017-06-27 |
| 1760915375 | Ruchie Bhattarai | Internal Medicine | 2913 N Commonwealth Ave, Chicago, IL 60657-6211 | 2017-04-10 |
| 1821462268 | Presence Chicago Hospitals Network | Internal Medicine | 2913 N Commonwealth Ave, Chicago, IL 60657-6211 | 2015-11-23 |
| 1841662988 | Nicholas Hoffman Anderson | Counselor | 2913 N Commonwealth Ave, 6th Floor, Chicago, IL 60657-6211 | 2015-10-28 |
| 1124402383 | Willard Palustre | Internal Medicine | 2913 N Commonwealth Ave, Suite 204, Chicago, IL 60657-6211 | 2015-07-16 |
| 1134516784 | Divya Sreeramoju | Student in an Organized Health Care Education/Training Program | 2913 N Commonwealth Ave, Suite 204, Chicago, IL 60657-6211 | 2015-04-22 |
| 1588072540 | Chukwuka Godwin Okolo | Internal Medicine | 2913 N Commonwealth Ave, Suite 204, Chicago, IL 60657-6211 | 2014-07-22 |
| 1578974333 | Dominika Schnabel | Student in an Organized Health Care Education/Training Program | 2913 N Commonwealth Ave, Suite 204, Chicago, IL 60657-6211 | 2014-05-15 |
| 1558600700 | Sara Lauer Tigay | Counselor | 2913 N Commonwealth Ave, 6th Floor, Chicago, IL 60657-6211 | 2013-02-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303887 | Simone Paes | Behavior Technician | 3141 N Sheffield Ave, Chicago, IL 60657 | 2020-10-13 |
| 1821613175 | Samridhi Khatri | Internal Medicine | 836 W. Wellington Ave, Advocate Illinois Masonic Medica, Suite 1312, Chigaco, IL 60657 | 2020-06-12 |
| 1467074617 | Dewolfe Aesthetic Services Sc | Surgery | 3357 N. Southport Aveune, Chicago, IL 60657 | 2020-05-11 |
| 1790304657 | Mehr Amer Mjeed | Student in an Organized Health Care Education/Training Program | Advocate Internal Medicine Clinic, Advocate Illinois Ma, 836 West Wellington Avenue, Chicago, IL 60657 | 2020-04-10 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1306493408 | Art of Sight Eyecare, LLC | Optometrist | 2915 N. Broadway, Chicago, IL 60657 | 2019-08-22 |
| 1992359277 | Joseph Michael Rochford IIi | Counselor | 1358 W Belmont Ave, Unit # 202, Chicago, IL 60657 | 2019-07-25 |
| 1487116240 | Conrad Petersen Dermatology Sc | Dermatology | 2845 N Sheridan, Chicago, IL 60657 | 2019-04-02 |
| 1003388810 | Evolve Wellness S.c. | Counselor | 2845 North Sheridan Road, Suite 708, Chicago, IL 60657 | 2018-12-19 |
| 1639657414 | Advocate North Side Health Network | Psychiatric Unit | 836 W Wellington Ave., Chicago, IL 60657 | 2018-08-02 |
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| Taxonomy Code | 2086X0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Surgical Oncology |
| A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research. |
| Notes: Source: Society of Surgical Oncology, 2007 [1/1/2008: definition added, source added, 7/1/2009: definiition reformatted] Additional Resources: http://www.surgonc.org/ ; American Board of Medical Specialties, 2007, www.abms.org ; American Board of Surgery, 2007, http://www.absurgery.org/ Surgical oncology is a recognized fellowship subspecialty program of surgery. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588662928 | Swati Kulkarni | Surgery | 250 E Superior St, Suite 420, Chicago, IL 60611-2914 | 2005-07-11 |
| 1235424656 | Fadi Suhail Dahdaleh | Surgery | 5841 S. Maryland Avenue, M/c 6040, Chicago, IL 60637 | 2011-06-14 |
| 1245556406 | Oliver S. Eng | Surgery | 5841 S Maryland Ave # Mc5094, Chicago, IL 60637-1443 | 2010-04-13 |
| 1699008706 | S. O. Group, S.c. | Surgery | 1725 W. Harrison Street, Suite 409, Chicago, IL 60612 | 2009-09-09 |
| 1942457072 | Anthony Yang | Surgery | 675 N Saint Clair St Ste 21-700, Chicago, IL 60611-5975 | 2008-08-20 |
| 1922265032 | Rohit Ramesh Sharma | Surgery | 5841 S Maryland Ave, Mc 6040, Chicago, IL 60637-1447 | 2008-05-18 |
| 1508085630 | Board of Trustees of The University of Illinois | Surgery | 840 S Wood St, Chicago, IL 60612-7322 | 2007-04-25 |
| 1528114501 | Cdn Surgical Assoc., Ltd. | Surgery | 2913 N Commonwealth Ave, Chicago, IL 60657-6211 | 2007-01-25 |
| 1629171822 | Donald K Wood | Surgery | 1740 W Taylor St, Chicago, IL 60612-7232 | 2006-09-06 |
| 1275636482 | Tapas K. Dasgupta | Surgery | 1740 W Taylor St, Chicago, IL 60612-7232 | 2006-09-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.