Provider Demographics
NPI:1922123728
Name:MAESE, FEDERICO (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:
Last Name:MAESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 E OVILLA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2616
Mailing Address - Country:US
Mailing Address - Phone:469-719-3690
Mailing Address - Fax:469-719-3680
Practice Address - Street 1:269 E OVILLA RD STE 100
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2616
Practice Address - Country:US
Practice Address - Phone:469-719-3690
Practice Address - Fax:469-719-3680
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4319207Q00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1312708-01Medicaid
TX131230801Medicaid
TX131230801Medicaid
TX1312708-01Medicaid