Provider Demographics
NPI:1437310844
Name:DEVINDER K. MAKKER, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DEVINDER K. MAKKER, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAKKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-833-0272
Mailing Address - Street 1:1530 BESSIE AVE
Mailing Address - Street 2:#104
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3080
Mailing Address - Country:US
Mailing Address - Phone:209-833-0272
Mailing Address - Fax:
Practice Address - Street 1:1530 BESSIE AVE
Practice Address - Street 2:#104
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3080
Practice Address - Country:US
Practice Address - Phone:209-833-0272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty