Provider Demographics
NPI:1861771149
Name:CONWAY, ERIC MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:CONWAY
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:303 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2586
Practice Address - Country:US
Practice Address - Phone:630-527-6345
Practice Address - Fax:331-221-3983
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2024-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085.004075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant