Provider Demographics
NPI:1346226925
Name:CONAWAY, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CONAWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4188 HOBBS LANDING DR W
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-6024
Mailing Address - Country:US
Mailing Address - Phone:614-467-0911
Mailing Address - Fax:614-798-0021
Practice Address - Street 1:6740 AVERY MUIRFIELD DR
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1238
Practice Address - Country:US
Practice Address - Phone:614-467-0911
Practice Address - Fax:614-798-0021
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179275Medicaid
OHH078280Medicare PIN
OHG18572Medicare UPIN
OHCO0803797Medicare ID - Type Unspecified