Provider Demographics
NPI:1689644650
Name:CONRAD, HAROLD A (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:A
Last Name:CONRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 MICHIGAN NE
Practice Address - Street 2:SUITE 4150
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-267-2100
Practice Address - Fax:616-267-2101
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010711912080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3389769Medicaid
MI1922090554OtherGROUP NPI
MI350D176310OtherBCBS GROUP
MI0M74460050OtherMEDICARE ID
MI1558407189OtherGROUP NPI
MI350D176310OtherBCBS GROUP