Provider Demographics
NPI:1720278666
Name:BRYAN, MICHAEL CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CONRAD
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:22 WATERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2066
Mailing Address - Country:US
Mailing Address - Phone:860-678-3402
Mailing Address - Fax:844-364-3181
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 308
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4710
Practice Address - Country:US
Practice Address - Phone:623-412-2229
Practice Address - Fax:602-314-5843
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2021-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ37126207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ411665OtherMEDICAID
AZ411665OtherMEDICAID