1568421030 NPI number — DR. DEVINDER K MAKKER MD

Table of content: DR. DEVINDER K MAKKER MD (NPI 1568421030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568421030 NPI number — DR. DEVINDER K MAKKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKKER
Provider First Name:
DEVINDER
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAKKER
Provider Other First Name:
DEVINDER
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568421030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 W 11TH ST
Provider Second Line Business Mailing Address:
# 119
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-833-0272
Provider Business Mailing Address Fax Number:
209-839-8473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
632 W 11TH ST
Provider Second Line Business Practice Location Address:
# 119
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95376-3856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-833-0272
Provider Business Practice Location Address Fax Number:
209-839-8473
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A044215 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A442150 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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