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Active NPI 1417469404 Organization (Entity Type 2)

Maksportsmd

Family Medicine - Sports Medicine • Bothell, WA

About Maksportsmd NPI 1417469404 Summary

Maksportsmd is a verified healthcare organization specializing in Family Medicine - Sports Medicine operating in Bothell, WA. Located at 19110 BOTHELL WAY NE STE 102, this facility provides patient care and medical services under National Provider Identifier (NPI) 1417469404.

Administrative operations and authorized compliance are overseen by Abimbolu Makinde (Owner).

The facility is associated with 1 linked healthcare practitioner providing clinical services.

Facility Location & Contact Primary Location

Facility Address

19110 Bothell Way Ne Ste 102

Bothell, WA 980112970

Telephone 4252868271
Fax 4254917271

Authorized Official Information

Authorized Contact Name

Abimbolu Makinde , MD

Title / Role

Owner

Official Telephone

4252868271

Facility Classifications & Specialties

Family Medicine - Sports Medicine Primary Taxonomy

NUCC Taxonomy Code: 207QS0010X

A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

1 Linked

Family Medicine - Sports Medicine

Bothell, WA

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active October 30, 2017

NPI status registered as active in NPPES database

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Updated Practice Location October 30, 2017

Registered at 19110 BOTHELL WAY NE STE 102, BOTHELL, WA 980112970 (Tel: 4252868271)

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Updated Business Mailing Address October 30, 2017

Registered at 19110 BOTHELL WAY NE STE 102, BOTHELL, WA 980112970

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Organization / Clinic Name Updated October 30, 2017

Operating as MAKSPORTSMD

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 30, 2017

Family Medicine (License #60465979 in WA)

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Initial NPI Registration & Enumeration October 30, 2017

First registered as active Healthcare Organization in NPPES Database.

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NPI Organization Metadata

NPI Number: 1417469404
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: October 30, 2017
Last Update: October 30, 2017

Mailing Address

19110 Bothell Way Ne Ste 102

Bothell, WA 980112970

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.