MEDICARE: LINDA MAK, MD, INC.

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	207ND0101X	MOHS-Micrographic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W15903	OTHER	CA	MEDICARE PROVIDER

General Provider Information

NPI Number	:	1730115155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDA MAK, MD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2678
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92244-2678
Country	:	US
Telephone Number	:	760-353-0574
Fax Number	:	760-353-0397

Provider Business Practice Location Address
First Line	:	1745 S IMPERIAL AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4243
Country	:	US
Telephone Number	:	760-353-0574
Fax Number	:	760-353-0397

Authorized Official
Title or Position	:	DR
Name	:	DR. LINDA L MAK
Credential	:	MD
Telephone Number	:	760-353-0574

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	11/12/2007

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