Provider Demographics
NPI:1518928423
Name:CONDIT, DONALD PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:PATRICK
Last Name:CONDIT
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 1:1000 E PARIS AVE SE
Mailing Address - Street 2:STE 115
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-954-1442
Mailing Address - Fax:616-954-1446
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:STE 115
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3680
Practice Address - Country:US
Practice Address - Phone:616-954-1442
Practice Address - Fax:616-954-1446
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404809207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4505737Medicaid
MI2004101221OtherBCBSM
MI4732234Medicaid
MI4732225Medicaid
MI4732234Medicaid