Provider Demographics
NPI:1780667683
Name:CONRARDY, PHILIP G (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:G
Last Name:CONRARDY
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 1:7620 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-5002
Mailing Address - Country:US
Mailing Address - Phone:414-444-6000
Mailing Address - Fax:888-664-5360
Practice Address - Street 1:7620 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-5002
Practice Address - Country:US
Practice Address - Phone:414-444-6000
Practice Address - Fax:888-664-5360
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124777207LP2900X
WI37204-020207L00000X
WI30724-20207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050059549OtherRAIL ROAD MEDICARE
WI31916700Medicaid
050059549OtherRAIL ROAD MEDICARE
WIWI3121002Medicare PIN
WI0007-65215Medicare ID - Type UnspecifiedPROVIDER NUMBER