Individual
DR. MICHAEL CASSIDEY MAXTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1000
Mailing address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
24810
MS
207X00000X
Orthopaedic Surgery Physician
29231
OK
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
24810
MS
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
29231
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200445880A
—
OK
Enumeration date
05/30/2012
Last updated
07/02/2019
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