Healthcare Provider Details

I. General information

NPI: 1831392083
Provider Name (Legal Business Name): MILES B. CONRAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

1001 POTRERO AVE BLDG. 5, 1ST FL.
SAN FRANCISCO CA
94110-3510
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1300
  • Fax:
Mailing address:
  • Phone: 628-206-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA105381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA105381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: