Healthcare Provider Details

I. General information

NPI: 1184552713
Provider Name (Legal Business Name): DAWN RENEE KONDOR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN KONDOR OD

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD BLDG 3
BATTLE CREEK MI
49037-7314
US

IV. Provider business mailing address

12345 DOWNES ST NE
LOWELL MI
49331-9762
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax:
Mailing address:
  • Phone: 616-469-7109
  • Fax:

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 StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: