Individual
MR. MICHAEL LLOYD MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP,LP
Contact information
Practice address
4301 N CLASSEN BLVD, OKLAHOMA CITY, OK 73118-5031
(405) 525-4000
(405) 530-3670
Mailing address
4301 N CLASSEN BLVD, OKLAHOMA CITY, OK 73118-5031
(405) 525-4000
(405) 530-3670
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
LP30
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP2599
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS & PROSTHETICS
—
01
—
LP30
OKLAHOMA BOARD OF MEDICAL LICENSURE & SUPERVISION FOR ORTHOTICS & PROSTHETICS
OK
Enumeration date
07/09/2012
Last updated
07/09/2012
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