Maksportsmd

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

60465979 Issued in WA

Legal business name

MAKSPORTSMD

Practice address

19110 Bothell Way NE Ste 102
Bothell, WA 98011-2970

Phone

(425) 286-8271

Fax

(425) 491-7271

NPI assigned

Oct 30, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abimbolu Makinde, MDNPI 1669769337

Title

Owner

Phone

(425) 286-8271

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abimbolu S. Makinde, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Bothell, WA
  • NPI 1669769337
  Medicare reassignment NPD Authorized official
• Yanqun Bu

  • Nurse Practitioner
  • Everett, WA
  • NPI 1457697526
  Medicare reassignment NPD
• Amanda Sue Macklin, ARNP

  • Gerontology Nurse Practitioner
  • Tacoma, WA
  • NPI 1740707967
  Medicare reassignment NPD
• Jessica Lyn Taylor, ARNP-C

  • Nurse Practitioner
  • Tacoma, WA
  • NPI 1851069538
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509321600000",
    "number": "1417469404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19110 BOTHELL WAY NE STE 102",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980112970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19110 BOTHELL WAY NE STE 102",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980112970",
            "telephone_number": "425-286-8271",
            "fax_number": "425-491-7271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKSPORTSMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2017-10-30",
        "status": "A",
        "authorized_official_last_name": "MAKINDE",
        "authorized_official_first_name": "ABIMBOLU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-286-8271",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WA",
            "license": "60465979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Donahue Mahr, DPT
• Mike Mai
• Isabel Wanjiku Maina
• Claire Makepeace
• Abimbolu S. Makinde, M.D.
• Theresa Malamel
• Lucy Rae Mallory, CBT
• Ashtin Mancinelli, LMHC
• Manjote Dhaliwal DDS PLLC
• Isaiah James Manley

• Sports Medicine (Family Medicine) Physician in Bothell, WA
• Providers in Bothell, WA by specialty
• Sports Medicine (Family Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.