DR. NIKOLA CENGELOVA CONRAD (NPI# 1013279371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013279371 |
| Entity Type | Individual |
| Full Name | DR. NIKOLA CENGELOVA CONRAD |
| Credential | M.D. |
| Practice Address |
21400 E 11 Mile Rd Saint Clair Shores MI 48081-1566 |
| Mailing Address |
130 Town Center Dr 203 Troy MI 48084-1744 |
| Practice Telephone | 5864984400 |
| Practice Fax Number | 5864984440 |
| Mailing Telephone | 2485858265 |
| Mailing Fax Number | 2485858270 |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2015-07-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 4301101196 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
21400 E 11 MILE RD |
| City | SAINT CLAIR SHORES |
| State | MI |
| Zip Code | 48081-1566 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063034296 | Denise Thi Nguyen | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2020-05-11 |
| 1437770849 | Lindsay Marie Smith | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2020-04-27 |
| 1659990059 | Mark Peter Mastromonaco | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2020-04-15 |
| 1871155622 | Eman Bazzi | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2019-07-02 |
| 1902467061 | Devan Dykstra | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2019-06-27 |
| 1104351402 | Dylan Ryan Rogers | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2017-04-24 |
| 1073961884 | Sarah Gammouh | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2016-06-02 |
| 1275952764 | Robert James Mcclowry | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2014-04-10 |
| 1700220654 | Shruti Ramakrishna | Family Medicine | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1566 | 2013-04-22 |
| 1497078364 | Lakeview Specialty Pharmacy Inc | Pharmacy | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1502 | 2010-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750865416 | Saint Clair Family Pharmacy LLC | Pharmacy | 28001 Harper Ave., Saint Clair Shores, MI 48081 | 2018-09-19 |
| 1669995783 | Terra Laquay Ginther | Social Worker | 28800 Harper Ave Ste A, Saint Clair Shores, MI 48081 | 2017-07-20 |
| 1245676998 | Julia Hanson | Social Worker | 27941 Harper Ave., Suite 105, St. Clair Shores, MI 48081 | 2013-05-21 |
| 1760731301 | Life Transition Service | Community/Behavioral Health | 21031 Sunnydale, St. Clair Shore, MI 48081 | 2012-08-29 |
| 1477868792 | William Burr Wood | Pharmacist | 21000 Twelve Milerd., St Clair Shores, MI 48081 | 2010-08-11 |
| 1508094350 | Dominic Anthony Garrisi | Anesthesiology | 21018 Bon Brae, St. Clair Shores, MI 48081 | 2009-06-30 |
| 1992947022 | Karen Ostrowski-thomas | Occupational Therapist | 22442 Bayview, St. Clair Shores, MI 48081 | 2009-04-06 |
| 1891979787 | Chirag Rachhadia | Physical Therapist | 29150 Harper Avenue, St. Clair Shores, MI 48081 | 2007-12-27 |
| 1598955114 | Donna Warner Manczak | Psychologist | 21400 E Eleven Mil Rd, St Clair Shores, MI 48081 | 2007-07-30 |
| 1467652347 | Sumit Narayanprasad Fogla | Family Medicine | 21400 E Eleven Mile Road, St. Clair Shores, MI 48081 | 2007-07-19 |
| Find all providers in zip 48081 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750818118 | Dayna E Snyder | Family Medicine | 20225 E 9 Mile Rd Ste 100a, Saint Clair Shores, MI 48080-1700 | 2017-05-16 |
| 1962882910 | Ali Tarif Bazzy | Family Medicine | 20225 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080 | 2015-06-04 |
| 1407161086 | Audrey M Sim Pllc | Family Medicine | 25915 Harper Ave Ste B, Saint Clair Shores, MI 48081-3770 | 2010-08-08 |
| 1083875702 | Mark B Alrais | Family Medicine | 21600 Harper Ave Ste 100, Saint Clair Shores, MI 48080-2242 | 2008-06-25 |
| 1245327691 | Naira S. Henein | Family Medicine | 21510 Harper Ave, Saint Clair Shores, MI 48080-2211 | 2006-10-06 |
| 1154437416 | Carolyn Emily Nine | Family Medicine | 22646 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080-1951 | 2006-08-21 |
| 1124049705 | Carey Marie Vigor | Family Medicine | 24001 Greater Mack Ave Ste A, Saint Clair Shores, MI 48080-1471 | 2006-07-21 |
| 1376503151 | Rachel Eileen O'byrne | Family Medicine | 21099 Masonic Blvd, Saint Clair Shores, MI 48082-1045 | 2006-03-24 |
| 1407822612 | Laurie Jean Rudnick | Family Medicine | 19901 E 10 Mile Rd, Saint Clair Shores, MI 48080-1069 | 2006-02-27 |
| 1275525966 | Sigmund O Mcintyre | Family Medicine | 24911 Little Mack Ave Ste C, Saint Clair Shores, MI 48080-3200 | 2005-08-18 |
| Find all providers in SAINT CLAIR SHORES | ||||
| City | SAINT CLAIR SHORES |
| Zip Code | 48081 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.