Healthcare Provider Details

I. General information

NPI: 1295708659
Provider Name (Legal Business Name): RICHARD L MAKOWIEC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/14/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 PENNSYLVANIA ST
INDIANAPOLIS IN
46220
US

IV. Provider business mailing address

6520 PENNSYLVANIA ST
INDIANAPOLIS IN
46220
US

V. Phone/Fax

Practice location:
  • Phone: 773-425-3562
  • Fax:
Mailing address:
  • Phone: 773-425-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01050271A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036095190
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number01050271A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: