Provider Demographics
NPI:1003870403
Name:CONRAD, ROSELIA SCHLICHTIG (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSELIA
Middle Name:SCHLICHTIG
Last Name:CONRAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ROSELIA
Other - Middle Name:MARIA
Other - Last Name:SCHLICHTIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:77-6539 ALII DR B
Mailing Address - Street 2:
Mailing Address - City:KAILUA-KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:808-322-0141
Mailing Address - Fax:
Practice Address - Street 1:77-6539 ALII DR B
Practice Address - Street 2:
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-322-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS978207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI102691Medicare PIN
HIF87504Medicare UPIN