Provider Demographics
NPI:1407523178
Name:CONLEY, MICHAEL EUGENE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:CONLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6953 STATE ROUTE 219 LOT 33
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-7107
Mailing Address - Country:US
Mailing Address - Phone:419-953-2387
Mailing Address - Fax:
Practice Address - Street 1:6953 STATE ROUTE 219 LOT 33
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-7107
Practice Address - Country:US
Practice Address - Phone:419-953-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health