Provider Demographics
NPI:1740373299
Name:KAWEL, CONRAD ANDREW III (MD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:ANDREW
Last Name:KAWEL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:23345 GLENCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3038
Mailing Address - Country:US
Mailing Address - Phone:248-471-6588
Mailing Address - Fax:
Practice Address - Street 1:20220 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1412
Practice Address - Country:US
Practice Address - Phone:248-471-4600
Practice Address - Fax:248-471-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18636621001Medicaid
MIOM50530Medicare ID - Type Unspecified
MI18636621001Medicaid