Michael D. Rader M.D., P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

18832 Issued in OK

Legal business name

MICHAEL D. RADER M.D., P.C.

Practice address

1121 W 3Rd St
Elk City, OK 73644-5103

Phone

(580) 243-3376

Fax

(580) 243-3377

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael David Rader, M.D.NPI 1619966108

Title

Owner

Phone

(580) 243-3376

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 1

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

• Michael David Rader, M.D.

  • Dermatology Physician
  • Elk City, OK
  • NPI 1619966108
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1710066345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 W 3RD ST",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736445103",
            "telephone_number": "580-243-3376",
            "fax_number": "580-243-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W 3RD ST",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736445103",
            "telephone_number": "580-243-3376",
            "fax_number": "580-243-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D. RADER M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "RADER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-243-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "OK",
            "license": "18832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Elk City, OK
• Providers in Elk City, OK by specialty
• Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; 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.