Healthcare Provider Details

I. General information

NPI: 1144632092
Provider Name (Legal Business Name): ROBERT MAKISHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CAPITAL DR
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4100
  • Fax: 740-779-4149
Mailing address:
  • Phone: 740-779-4222
  • Fax: 740-779-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.130267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: