Healthcare Provider Details

I. General information

NPI: 1750709572
Provider Name (Legal Business Name): TAREK MAKKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MACK AVE
DETROIT MI
48201-2466
US

IV. Provider business mailing address

311 MACK AVE
DETROIT MI
48201-2466
US

V. Phone/Fax

Practice location:
  • Phone: 888-362-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301117288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: