Provider Demographics
NPI:1164462057
Name:GILES, CONRAD (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:GILES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400 - CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-594-6702
Mailing Address - Fax:248-594-6738
Practice Address - Street 1:26400 W 12 MILE RD
Practice Address - Street 2:STE 60
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1700
Practice Address - Country:US
Practice Address - Phone:248-594-6702
Practice Address - Fax:248-594-6738
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-07-20
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Provider Licenses
StateLicense IDTaxonomies
MI4301022841207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630233Medicare PIN