Provider Demographics
NPI:1225002199
Name:MAKIEVE, DANIEL MERRITT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MERRITT
Last Name:MAKIEVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5134
Mailing Address - Country:US
Mailing Address - Phone:916-784-4050
Mailing Address - Fax:
Practice Address - Street 1:801 STERLING PKWY
Practice Address - Street 2:#120
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7326
Practice Address - Country:US
Practice Address - Phone:916-408-3773
Practice Address - Fax:916-408-3853
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A611991Medicare PIN
CAG50342Medicare UPIN