Provider Demographics
NPI:1275290587
Name:MK HEALTHCARE PLLC
Entity Type:Organization
Organization Name:MK HEALTHCARE PLLC
Other - Org Name:MK HEALTHCARE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KIANINEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-819-6141
Mailing Address - Street 1:3501 S CORONA ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3907
Mailing Address - Country:US
Mailing Address - Phone:720-819-6141
Mailing Address - Fax:
Practice Address - Street 1:3501 S CORONA ST STE 1
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3907
Practice Address - Country:US
Practice Address - Phone:720-487-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty