Healthcare Provider Details

I. General information

NPI: 1821221490
Provider Name (Legal Business Name): MICHAEL DEAN CONRAD PC/CR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6370 WISE AVE NW
CANTON OH
44720-7350
US

IV. Provider business mailing address

6370 WISE AVE NW
CANTON OH
44720-7350
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-0083
  • Fax: 330-493-3689
Mailing address:
  • Phone: 330-493-0083
  • Fax: 330-493-3689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0500075
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: