Provider Demographics
NPI:1144335704
Name:CONRAD, MICHAEL D (NP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:CONRAD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:14150 CULVER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0322
Mailing Address - Country:US
Mailing Address - Phone:949-552-4584
Mailing Address - Fax:949-551-5612
Practice Address - Street 1:14150 CULVER DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0322
Practice Address - Country:US
Practice Address - Phone:949-552-4584
Practice Address - Fax:949-551-5612
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP 15571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 15571OtherNP LICENSE
CAEFF: 6/11/12-RIALTOMedicaid
CAEFF:6/11/12 ADELANTOMedicaid
CAEFF: 6/11/12-S BERNMedicaid
CAEFF:6/11/12 ADELANTOMedicaid
CANP 15571OtherNP LICENSE
CAEFF: 6/11/12-S BERNMedicaid