Healthcare Provider Details

I. General information

NPI: 1164367710
Provider Name (Legal Business Name): MIKHAIL KONDRATIUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT STREET, BRIDGEPORT HOSPITAL GME OFFICE
BRIDGEPORT CT
06610
US

IV. Provider business mailing address

267 GRANT STREET, BRIDGEPORT HOSPITAL GME OFFICE
BRIDGEPORT CT
06610
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3792
  • Fax: 203-384-4294
Mailing address:
  • Phone: 203-384-3792
  • Fax: 203-384-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: