Provider Demographics
NPI:1346952322
Name:MMK LLC
Entity Type:Organization
Organization Name:MMK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HAWANYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-464-0774
Mailing Address - Street 1:550 W PLUMB LN STE B-157
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3468
Mailing Address - Country:US
Mailing Address - Phone:775-432-2200
Mailing Address - Fax:775-432-2992
Practice Address - Street 1:540 W PLUMB LN STE 120
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3691
Practice Address - Country:US
Practice Address - Phone:775-432-2200
Practice Address - Fax:775-432-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty