Provider Demographics
NPI:1407072309
Name:URBAN, CONRAD J (MD)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:J
Last Name:URBAN
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 1:567 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7784
Mailing Address - Country:US
Mailing Address - Phone:815-469-8722
Mailing Address - Fax:773-265-3340
Practice Address - Street 1:567 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-7784
Practice Address - Country:US
Practice Address - Phone:815-469-8722
Practice Address - Fax:773-265-3340
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021600164OtherBCBS ID #
IL451680Medicare ID - Type UnspecifiedPROVIDER ID#
ILC41085Medicare UPIN