Provider Demographics
NPI:1487632238
Name:EM, MAKKALEARN (MD)
Entity Type:Individual
Prefix:
First Name:MAKKALEARN
Middle Name:
Last Name:EM
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 1:875 OAK ST SE
Mailing Address - Street 2:STE 3010
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-399-7520
Mailing Address - Fax:503-362-7344
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:STE 3010
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-399-7520
Practice Address - Fax:503-362-7344
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25645207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213292Medicaid
OR131830Medicare ID - Type Unspecified
OR213292Medicaid