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General NPI Number Information
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NPI Number | 1700831294
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Entity Type | Individual
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Provider Name | MATTHEW HARRIS CONRAD M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 1700 WATERFRONT PKWY #200
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City | WICHITA
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State | KS
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Zip | 67206-6614
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Country | US
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Telephone | 316-681-2227
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Fax | 316-684-5250
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Provider Business Mailing Address
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Address Line | 1700 N WATERFRONT PKWY #200
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City | WICHITA
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State | KS
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Zip | 67206-6618
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Country | US
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Telephone | 316-681-2227
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Fax | 316-684-5250
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | KS0429556
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | KS0429556
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License Number State | KS
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