Provider Demographics
NPI:1245489632
Name:MATTHEW H. CONRAD, MD, PA
Entity type:Organization
Organization Name:MATTHEW H. CONRAD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-681-2227
Mailing Address - Street 1:1700 WATERFRONT PKWY
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-6614
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:BLDG 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100421630AMedicaid
KSH62361Medicare UPIN