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General NPI Number Information
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NPI Number | 1013279371
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Entity Type | Individual
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Provider Name | NIKOLA CENGELOVA CONRAD M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 966 BARTLEY ST
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City | JASPER
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State | IN
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Zip | 47546-2641
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Country | US
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Telephone | 812-996-7810
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Fax | 812-996-8465
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Provider Business Mailing Address
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Address Line | PO BOX 631767
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City | CINCINNATI
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State | OH
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Zip | 45263-1767
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Country | US
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Telephone | 812-450-6815
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Fax | 812-450-6822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01082207A
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License Number State | IN
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