Healthcare Provider Details

I. General information

NPI: 1255334421
Provider Name (Legal Business Name): MARK WILLIAM CONRADT AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E BELL ST
NEENAH WI
54956-4993
US

IV. Provider business mailing address

5195 KILLDEER LN
OSHKOSH WI
54901-1374
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-1768
  • Fax: 920-969-1788
Mailing address:
  • Phone: 920-729-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number11
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: