Provider Demographics
NPI:1497817118
Name:CONNOR, MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CONNOR
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 1:27 DANBURY RD FL 3
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4405
Mailing Address - Country:US
Mailing Address - Phone:203-761-1230
Mailing Address - Fax:203-761-6767
Practice Address - Street 1:27 DANBURY RD FL 3
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4405
Practice Address - Country:US
Practice Address - Phone:203-761-1230
Practice Address - Fax:203-761-6767
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT474213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT04091617Medicaid
CT480000481Medicare PIN
CTT86140Medicare UPIN