Healthcare Provider Details

I. General information

NPI: 1497674519
Provider Name (Legal Business Name): CONNER PAVONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S WASHINGTON AVE STE 219
ROYAL OAK MI
48067-3833
US

IV. Provider business mailing address

306 S WASHINGTON AVE STE 219
ROYAL OAK MI
48067-3833
US

V. Phone/Fax

Practice location:
  • Phone: 248-891-7608
  • Fax:
Mailing address:
  • Phone: 248-891-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: