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General NPI Number Information
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NPI Number | 1871547513
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Entity Type | Individual
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Provider Name | MATTHEW IAN MAKI D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 32747 KELLY BLVD
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City | BROWNSTOWN
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State | MI
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Zip | 48173-8634
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Country | US
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Telephone | 313-610-0489
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | WYANDOTTE
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State | MI
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Zip | 48192-0262
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Country | US
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Telephone | 313-610-0489
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901002098
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License Number State | MI
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