Provider Demographics
NPI:1033113832
Name:CONRAD, DAN P (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:P
Last Name:CONRAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 STURGIS RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0321
Mailing Address - Country:US
Mailing Address - Phone:605-348-6180
Mailing Address - Fax:605-348-9121
Practice Address - Street 1:3641 STURGIS RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0321
Practice Address - Country:US
Practice Address - Phone:605-348-6180
Practice Address - Fax:605-348-9121
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD142213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6801050Medicaid
SD004563Medicare ID - Type Unspecified
SD6801050Medicaid