Provider Demographics
NPI:1568409761
Name:MAKOL, GEORGE J (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:MAKOL
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 1:2902 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2742
Mailing Address - Country:US
Mailing Address - Phone:520-322-8361
Mailing Address - Fax:520-322-8462
Practice Address - Street 1:2902 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2742
Practice Address - Country:US
Practice Address - Phone:520-322-8361
Practice Address - Fax:520-322-8462
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10048207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23749702Medicaid
AZ24143Medicare ID - Type Unspecified
AZ23749702Medicaid