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General NPI Number Information
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NPI Number | 1861628430
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Entity Type | Individual
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Provider Name | NATHAN CLYDE CONDIE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 4660 S HAGADORN RD STE 500
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City | EAST LANSING
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State | MI
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Zip | 48823-6804
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Country | US
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Telephone | 517-884-8701
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Fax | 517-884-8787
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Provider Business Mailing Address
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Address Line | 804 SERVICE RD STE A202
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City | EAST LANSING
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State | MI
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Zip | 48824-7015
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Country | US
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Telephone | 517-884-8701
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Fax | 517-884-8787
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101018410
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 5101018410
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License Number State | MI
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