Healthcare Provider Details

I. General information

NPI: 1417983222
Provider Name (Legal Business Name): MAKABIS YOUSEFPOUR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S MAIN ST
MARYVILLE MO
64468-2655
US

IV. Provider business mailing address

2016 S MAIN ST
MARYVILLE MO
64468-2655
US

V. Phone/Fax

Practice location:
  • Phone: 660-562-7999
  • Fax: 660-562-7996
Mailing address:
  • Phone: 660-562-7999
  • Fax: 660-562-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2024022221
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1986
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: