Provider Demographics
NPI:1225240955
Name:MAKARY, MICHAEL MAMDOUH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MAMDOUH
Last Name:MAKARY
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 1:601 OMEGA DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2075
Mailing Address - Country:US
Mailing Address - Phone:817-465-5881
Mailing Address - Fax:817-465-6336
Practice Address - Street 1:911 MEDICAL CENTRE DR STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4758
Practice Address - Country:US
Practice Address - Phone:817-461-0201
Practice Address - Fax:817-861-3365
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3922207RP1001X
IN01081468A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304426501Medicaid
TXTXB159027Medicare PIN