Healthcare Provider Details

I. General information

NPI: 1497862304
Provider Name (Legal Business Name): MIGUEL A. CAMACHO, MD P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 WALNUT DR
ARDMORE OK
73401-2353
US

IV. Provider business mailing address

1104 WALNUT DR
ARDMORE OK
73401-2353
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-0543
  • Fax: 580-226-2284
Mailing address:
  • Phone: 580-226-0543
  • Fax: 580-226-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL A CAMACHO
Title or Position: PRESIDENT
Credential: MD
Phone: 580-226-0543