Provider Demographics
NPI:1942423140
Name:MICHAEL R & SHARIE S CONARD
Entity Type:Organization
Organization Name:MICHAEL R & SHARIE S CONARD
Other - Org Name:STUDIO I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-428-3400
Mailing Address - Street 1:2540 PAULMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9212
Mailing Address - Country:US
Mailing Address - Phone:269-428-3400
Mailing Address - Fax:269-428-4828
Practice Address - Street 1:2540 PAULMAR AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9212
Practice Address - Country:US
Practice Address - Phone:269-428-3400
Practice Address - Fax:269-428-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI853454698Medicaid
MI1038790001Medicare NSC