Provider Demographics
NPI:1386495851
Name:MCCORMICK, CONNOR JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:JAMES
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18001 ROTUNDA DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3984
Mailing Address - Country:US
Mailing Address - Phone:947-522-3088
Mailing Address - Fax:
Practice Address - Street 1:18001 ROTUNDA DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3984
Practice Address - Country:US
Practice Address - Phone:947-522-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43510521602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry