Active NPI
Michael J Davoli II, MD
- Orthopaedic Surgery Physician
- Yukon, OK
National Provider Identifier
1669450581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 23194
- Practice address
- 1651 Professional Circle
Yukon, OK 73099 - Phone
- (405) 350-6770
- Fax
- (405) 350-6768
- NPI assigned
- Jan 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 23194 | OK | Primary |
Addresses
Primary practice location
1651 Professional Circle
Yukon, OK 73099
Mailing address
5300 N Independence Ave
Suite 280
Oklahoma City, OK 73112-5556
Phone (405) 350-6770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200005660A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23194 | OK | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Center | Past | Accepting new patients | |
| Holy Cross Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- mdavoli15069@direct.integrisok.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
-
- Internal Medicine Physician
- Ft. Lauderdale, FL
- NPI 1467401877
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498435200000",
"number": "1669450581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 N INDEPENDENCE AVE",
"address_2": "SUITE 280",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731125556",
"telephone_number": "405-350-6770",
"fax_number": "405-350-6768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1651 PROFESSIONAL CIRCLE",
"city": "YUKON",
"state": "OK",
"postal_code": "73099",
"telephone_number": "405-350-6770",
"fax_number": "405-350-6768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVOLI",
"first_name": "MICHAEL",
"middle_name": "J",
"name_suffix": "II",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-03",
"last_updated": "2017-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "OK",
"license": "23194",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200005660A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yukon, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.