Provider Demographics
NPI:1508902370
Name:CONDEVAUX, CAROLE FERNANDE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:FERNANDE
Last Name:CONDEVAUX
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Gender:F
Credentials:MD
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Mailing Address - Street 1:6700 NORTH ROCHESTER ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306
Mailing Address - Country:US
Mailing Address - Phone:248-650-1534
Mailing Address - Fax:248-650-1537
Practice Address - Street 1:6700 NORTH ROCHESTER ROAD
Practice Address - Street 2:PAINT CREEK OBSETRICS AND GYNECOLOGY PC SUITE 112
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306
Practice Address - Country:US
Practice Address - Phone:248-650-1534
Practice Address - Fax:248-650-1537
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MICC052610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3382641Medicaid
MI3382641Medicaid
F40901Medicare UPIN