Provider Demographics
NPI:1801830187
Name:DONALD P CONDIT MD PLLC
Entity Type:Organization
Organization Name:DONALD P CONDIT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CONDIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-954-1442
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-954-1442
Mailing Address - Fax:616-954-1446
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 115
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3680
Practice Address - Country:US
Practice Address - Phone:616-954-1442
Practice Address - Fax:616-954-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404809207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2004101221OtherBLUE CROSS BLUE SHIELD
=========OtherTAX ID
MI2004101221OtherBLUE CROSS BLUE SHIELD