1033143045 NPI number — MAIKA HEALTHCARE, LLC

Table of content: (NPI 1033143045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033143045 NPI number — MAIKA HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAIKA HEALTHCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033143045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7552 NAVARRE PKWY
Provider Second Line Business Mailing Address:
SUITE # 13
Provider Business Mailing Address City Name:
NAVARRE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32566-7305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-939-9876
Provider Business Mailing Address Fax Number:
850-939-9877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7552 NAVARRE PKWY
Provider Second Line Business Practice Location Address:
SUITE # 13
Provider Business Practice Location Address City Name:
NAVARRE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32566-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-939-9876
Provider Business Practice Location Address Fax Number:
850-939-9877
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
TIEN MARK
Authorized Official Middle Name:
DUC
Authorized Official Title or Position:
SOLE OFFICER
Authorized Official Telephone Number:
850-939-9876

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME90850 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 271356000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: U3213Y . This is a "MEDICARE IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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