Provider Demographics
NPI:1407831951
Name:MARTIN, MICHAEL HUGH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HUGH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1711
Mailing Address - Country:US
Mailing Address - Phone:580-233-8220
Mailing Address - Fax:580-242-3909
Practice Address - Street 1:2501 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1711
Practice Address - Country:US
Practice Address - Phone:580-233-8220
Practice Address - Fax:580-242-3909
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK117213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T40764Medicare UPIN