Healthcare Provider Details

I. General information

NPI: 1184657728
Provider Name (Legal Business Name): MELANIE KONRADI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 G ST
SPRINGFIELD OR
97477-4113
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 541-735-9420
  • Fax: 541-747-9870
Mailing address:
  • Phone: 702-579-3203
  • Fax: 702-838-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD27001
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: