=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649463175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONRAD MAY M.D. LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3857 W WASHINGTON BLVD
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60624-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-533-1417
-----------------------------------------------------
Fax | 773-533-7348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3857 W WASHINGTON BLVD
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60624-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-533-1417
-----------------------------------------------------
Fax | 773-533-7348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. CONRAD MAY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 773-533-1417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 207QA0505X
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------