Provider Demographics
NPI:1518971365
Name:KS MAKKI PC
Entity Type:Organization
Organization Name:KS MAKKI PC
Other - Org Name:KHOSROW S MAKKI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-455-0923
Mailing Address - Street 1:7247 HANOVER PKWY
Mailing Address - Street 2:SUITES A & B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-345-5877
Mailing Address - Fax:301-345-5608
Practice Address - Street 1:7247 HANOVER PKWY
Practice Address - Street 2:SUITES A & B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-345-5877
Practice Address - Fax:301-345-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01962K01Medicare ID - Type Unspecified
B93511Medicare UPIN