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General NPI Number Information
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NPI Number | 1033143045
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Entity Type | Organization
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Legal Business Name | MAIKA HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 7552 NAVARRE PKWY SUITE # 13
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City | NAVARRE
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State | FL
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Zip | 32566-7305
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Country | US
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Telephone | 850-939-9876
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Fax | 850-939-9877
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Provider Business Mailing Address
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Address Line | 7552 NAVARRE PKWY SUITE # 13
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City | NAVARRE
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State | FL
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Zip | 32566-7305
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Country | US
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Telephone | 850-939-9876
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Fax | 850-939-9877
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Authorized Official
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Title or Position | SOLE OFFICER
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Name | TIEN MARK DUC TRAN
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Credential | M.D.
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Telephone | 850-939-9876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME90850
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License Number State | FL
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