Provider Demographics
NPI:1033143045
Name:MAIKA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MAIKA HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIEN MARK
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-939-9876
Mailing Address - Street 1:7552 NAVARRE PKWY
Mailing Address - Street 2:SUITE # 13
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7305
Mailing Address - Country:US
Mailing Address - Phone:850-939-9876
Mailing Address - Fax:850-939-9877
Practice Address - Street 1:7552 NAVARRE PKWY
Practice Address - Street 2:SUITE # 13
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7305
Practice Address - Country:US
Practice Address - Phone:850-939-9876
Practice Address - Fax:850-939-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271356000Medicaid
U3213YOtherMEDICARE IDENTIFICATION NUMBER
U3213YOtherMEDICARE IDENTIFICATION NUMBER
FL271356000Medicaid