Provider Demographics
NPI:1497935589
Name:PAUL MAKELA, M.D., P.C.
Entity Type:Organization
Organization Name:PAUL MAKELA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-870-9410
Mailing Address - Street 1:3011 W GRAND BLVD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3096
Mailing Address - Country:US
Mailing Address - Phone:313-870-9410
Mailing Address - Fax:313-870-9415
Practice Address - Street 1:3011 W GRAND BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3096
Practice Address - Country:US
Practice Address - Phone:313-870-9410
Practice Address - Fax:313-870-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056367207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4854371Medicaid
MIF81556Medicare UPIN
MI0P00120Medicare PIN