Individual
DR. CONRAD WITTRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBCHB
Contact information
Practice address
601 E FRONT AVE, SUITE 502, COEUR D ALENE, ID 83814-2701
(208) 415-0556
(208) 292-3130
Mailing address
601 E FRONT AVE, SUITE 502, COEUR D ALENE, ID 83814-2701
(208) 415-0556
(208) 292-3130
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
208156
MA
Other
Enumeration date
10/24/2005
Last updated
11/07/2012
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