Healthcare Provider Details

I. General information

NPI: 1801830187
Provider Name (Legal Business Name): DONALD P CONDIT MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE SUITE 115
GRAND RAPIDS MI
49546-3680
US

IV. Provider business mailing address

1000 E PARIS AVE SE SUITE 115
GRAND RAPIDS MI
49546-3680
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-1442
  • Fax: 616-954-1446
Mailing address:
  • Phone: 616-954-1442
  • Fax: 616-954-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4301404809
License Number StateMI

VIII. Authorized Official

Name: DONALD PATRICK CONDIT
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 616-954-1442