Healthcare Provider Details

I. General information

NPI: 1982197521
Provider Name (Legal Business Name): MANUEL MALDONADO-VITAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MANUEL MALDONADO MD

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 STANTON L YOUNG BLVD BMSB 451
OKLAHOMA CITY KS
73104
US

IV. Provider business mailing address

940 STANTON L YOUNG BLVD BMSB 451
OKLAHOMA CITY KS
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2451
  • Fax:
Mailing address:
  • Phone: 405-271-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number33832
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: