Provider Demographics
NPI:1518273424
Name:MICHAEL D CONAWAY MD LLC
Entity Type:Organization
Organization Name:MICHAEL D CONAWAY MD LLC
Other - Org Name:RIVERSIDE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-538-1358
Mailing Address - Street 1:4845 KNIGHTSBRIDGE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2463
Mailing Address - Country:US
Mailing Address - Phone:614-538-1358
Mailing Address - Fax:614-538-1316
Practice Address - Street 1:4845 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2463
Practice Address - Country:US
Practice Address - Phone:614-538-1358
Practice Address - Fax:614-538-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty