Provider Demographics
NPI:1518385020
Name:CONIGLIO, BRYAN D (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:CONIGLIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32255 NORTHWESTERN HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1505
Mailing Address - Country:US
Mailing Address - Phone:248-350-3190
Mailing Address - Fax:248-350-3245
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 120
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1505
Practice Address - Country:US
Practice Address - Phone:248-350-3190
Practice Address - Fax:248-350-3245
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.130905207RR0500X
MI4301511991207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228545Medicaid