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General NPI Number Information
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NPI Number | 1255334421
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Entity Type | Individual
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Provider Name | MARK WILLIAM CONRADT AU.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 119 E BELL ST
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City | NEENAH
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State | WI
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Zip | 54956-4993
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Country | US
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Telephone | 920-969-1768
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Fax | 920-969-1788
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Provider Business Mailing Address
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Address Line | 5195 KILLDEER LN
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City | OSHKOSH
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State | WI
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Zip | 54901-1374
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Country | US
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Telephone | 920-729-2085
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Fax |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 11
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License Number State | WI
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