Individual
CONRAD JOHN KELLEHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9471 CLARMONTE DRIVE, ST JOHN, IN 46373-9699
(219) 365-7676
Mailing address
9471 CLARMONTE DRIVE, ST JOHN, IN 46373-9699
(219) 365-7676
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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