Healthcare Provider Details

I. General information

NPI: 1043416787
Provider Name (Legal Business Name): MICHAEL ANTHONY PADILLA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N. PORTLAND AVE. SUITE 600
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PARKWAY 5TH FLOOR
OKLAHOMA CITY OK
73134
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-9940
  • Fax: 405-713-9941
Mailing address:
  • Phone: 405-713-9940
  • Fax: 405-713-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number31216
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: