MEDICARE: MIKHAIL KONDRATIUK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1164367710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKHAIL KONDRATIUK M.D.

Provider Business Mailing Address
First Line	:	267 GRANT STREET, BRIDGEPORT HOSPITAL
Second Line	:	GME OFFICE
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610
Country	:	US
Telephone Number	:	203-384-3792
Fax Number	:	203-384-4294

Provider Business Practice Location Address
First Line	:	267 GRANT STREET, BRIDGEPORT HOSPITAL
Second Line	:	GME OFFICE
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610
Country	:	US
Telephone Number	:	203-384-3792
Fax Number	:	203-384-4294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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