Provider Demographics
NPI:1528039914
Name:CONDOLEON, HARRY M (DO)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:M
Last Name:CONDOLEON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 S PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-3649
Mailing Address - Country:US
Mailing Address - Phone:515-295-7714
Mailing Address - Fax:
Practice Address - Street 1:1519 S PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-3649
Practice Address - Country:US
Practice Address - Phone:515-295-7714
Practice Address - Fax:515-295-4505
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02796208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502363Medicaid
NV100502363Medicaid