Healthcare Provider Details

I. General information

NPI: 1700114550
Provider Name (Legal Business Name): EDWARD JOHN CONLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3494 BEECHER RD
FLINT MI
48532-2735
US

IV. Provider business mailing address

G3494 BEECHER RD
FLINT MI
48532-2735
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-8677
  • Fax: 810-230-7855
Mailing address:
  • Phone: 810-230-8677
  • Fax: 810-230-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberEC008064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: