Basic Information
| Provider Information | |||||||||
| NPI: | 1538245212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONDICT | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10767 ILLINOIS ST STE 3000 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460328972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178171200 | ||||||||
| FaxNumber: | 3178171220 | ||||||||
| Practice Location | |||||||||
| Address1: | 10767 ILLINOIS ST STE 3000 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460328972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178171200 | ||||||||
| FaxNumber: | 3178171220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME 91878 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 01059847A | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200867940 | 05 | IN | MEDICAID |