MEDICARE: FEDERICO MAESE MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	J4319	TX
2	293D00000X	Physiological Laboratory
3	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	TXB145190	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J4319	OTHER	TX	LICENSE TX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508136052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEDERICO MAESE MD PA

Provider Business Mailing Address
First Line	:	269 E OVILLA RD STE 100
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-2616
Country	:	US
Telephone Number	:	469-719-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 E OVILLA RD STE 100
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-2616
Country	:	US
Telephone Number	:	469-719-3690
Fax Number	:	469-719-3680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FEDERICO MAESE
Credential	:	MD
Telephone Number	:	469-719-3690

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	02/07/2023

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Directions to “FEDERICO MAESE MD PA ” Practice Location

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