Provider Demographics
NPI:1851307052
Name:CONRAD, JEROME ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ARTHUR
Last Name:CONRAD
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 1:14875 TOMAHAWK LANE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-796-2417
Mailing Address - Fax:
Practice Address - Street 1:650 LINDEN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1879
Practice Address - Country:US
Practice Address - Phone:231-796-6721
Practice Address - Fax:231-796-1080
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJC026854207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1024277Medicaid
MIOM94510002Medicare ID - Type Unspecified
MI1024277Medicaid