Provider Demographics
NPI:1366428237
Name:MARA, MICHAEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 NE CUSHING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3887
Mailing Address - Country:US
Mailing Address - Phone:541-388-2333
Mailing Address - Fax:
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:STE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3730
Practice Address - Country:US
Practice Address - Phone:541-330-8226
Practice Address - Fax:541-318-0373
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19422207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR074435Medicaid
OR200026307OtherRAILROAD MEDICARE
ORG07337Medicare UPIN
OR074435Medicaid