Healthcare Provider Details

I. General information

NPI: 1982624433
Provider Name (Legal Business Name): MICHAEL AARON MASCHEK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MAIN ST
OPP AL
36467-1626
US

IV. Provider business mailing address

PO BOX 31463
BELFAST ME
04915-0167
US

V. Phone/Fax

Practice location:
  • Phone: 334-493-5704
  • Fax: 334-493-9535
Mailing address:
  • Phone: 251-200-3703
  • Fax: 334-493-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number351
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: