Provider Demographics
NPI:1538144001
Name:CONARD, MICHAEL G (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:CONARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3708 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-7218
Mailing Address - Country:US
Mailing Address - Phone:715-743-3101
Mailing Address - Fax:715-743-6242
Practice Address - Street 1:N3708 RIVER AVE
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-7218
Practice Address - Country:US
Practice Address - Phone:715-743-3101
Practice Address - Fax:715-743-6242
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI641-23363A00000X
WI641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000032Medicare Oscar/Certification
WIR91626Medicare UPIN
WI000007Medicare Oscar/Certification
WI000011Medicare Oscar/Certification
WI000101Medicare Oscar/Certification
WI000006Medicare Oscar/Certification
WI000025Medicare Oscar/Certification
WIP00046864Medicare Oscar/Certification
WI000023Medicare Oscar/Certification
WI000030Medicare Oscar/Certification