Provider Demographics
NPI:1275541773
Name:CONUI, CARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:CONUI
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 1:607 NORTH AVENUE
Mailing Address - Street 2:DOOR 17
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3271
Mailing Address - Country:US
Mailing Address - Phone:781-944-4044
Mailing Address - Fax:781-944-4050
Practice Address - Street 1:30 NEW CROSSING RD STE 311
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3271
Practice Address - Country:US
Practice Address - Phone:781-944-4044
Practice Address - Fax:781-944-4050
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADPM00310213E00000X
RI2127213E00000X
MA2127213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA480028283OtherMEDICARE RAILROAD
RICC45838Medicaid
RI29300-8/412344OtherBLUE CROSS BLUE SHIELD
MA0311049Medicaid
MAY71056OtherBLUE CROSS BLUE SHIELD
RICC45838Medicaid
MAY71056OtherBLUE CROSS BLUE SHIELD
RI007010069Medicare ID - Type Unspecified