MEDICARE: MOHAMMAD MAKKOUK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R3374	TX

General Provider Information

NPI Number	:	1467864686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD MAKKOUK MD

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 E PFLUGERVILLE PKWY
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-5998
Country	:	US
Telephone Number	:	512-654-6100
Fax Number	:	512-654-6100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	09/30/2021

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