Healthcare Provider Details

I. General information

NPI: 1063895845
Provider Name (Legal Business Name): MEGAN ELIZABETH CONWAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST 5TH FL
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-7275
  • Fax: 574-647-3696
Mailing address:
  • Phone: 574-647-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301500382
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4301500382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: