1346417029 NPI number — MICHAEL P CONRAD MD PA

Table of content: (NPI 1346417029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346417029 NPI number — MICHAEL P CONRAD MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL P CONRAD MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346417029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 EAST DESOTO STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-437-9997
Provider Business Mailing Address Fax Number:
850-439-2122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 EAST DESOTO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32501-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-437-9997
Provider Business Practice Location Address Fax Number:
850-439-2122
Provider Enumeration Date:
05/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CONRAD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-937-9997

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME0055242 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)