Provider Demographics
NPI:1700831294
Name:CONRAD, MATTHEW HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HARRIS
Last Name:CONRAD
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1700 N WATERFRONT PKWY
Mailing Address - Street 2:#200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-6618
Mailing Address - Country:US
Mailing Address - Phone:316-681-2227
Mailing Address - Fax:316-684-5250
Practice Address - Street 1:1700 WATERFRONT PKWY
Practice Address - Street 2:#200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-6614
Practice Address - Country:US
Practice Address - Phone:316-681-2227
Practice Address - Fax:316-684-5250
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSKS0429556174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100421630BMedicaid
KSH62361Medicare UPIN