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NPI Code Detail

MEDICARE: DR. MARK WILLIAM CONRADT AU.D.

MEDICARE: DR. MARK WILLIAM CONRADT AU.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologist11WI

General Provider Information

NPI Number : 1255334421
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK WILLIAM CONRADT AU.D.
Provider Business Mailing Address
First Line : 5195 KILLDEER LN
Second Line :
City : OSHKOSH
State : WI
Zip : 54901-1374
Country : US
Telephone Number : 920-729-2085
Fax Number :
Provider Business Practice Location Address
First Line : 119 E BELL ST
Second Line :
City : NEENAH
State : WI
Zip : 54956-4993
Country : US
Telephone Number : 920-969-1768
Fax Number : 920-969-1788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/03/2024

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