Healthcare Provider Details

I. General information

NPI: 1245489632
Provider Name (Legal Business Name): MATTHEW H. CONRAD, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WATERFRONT PKWY BLDG 200
WICHITA KS
67206-6614
US

IV. Provider business mailing address

1700 WATERFRONT PKWY BUILDING 200
WICHITA KS
67206-6614
US

V. Phone/Fax

Practice location:
  • Phone: 316-681-2227
  • Fax: 316-684-5250
Mailing address:
  • Phone: 316-681-2227
  • Fax: 316-684-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN K CONRAD
Title or Position: BUSINESS MANAGER
Credential: RN
Phone: 316-681-2227