Provider Demographics
NPI:1467435289
Name:CONRARDY, ANTHONY G (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:CONRARDY
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 1:2488 GOLFSIDE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1383
Mailing Address - Country:US
Mailing Address - Phone:262-914-0754
Mailing Address - Fax:
Practice Address - Street 1:2488 GOLFSIDE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1383
Practice Address - Country:US
Practice Address - Phone:262-914-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43809207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WII00330Medicare UPIN
WI34456800Medicaid