Provider Demographics
NPI:1568421030
Name:MAKKER, DEVINDER K (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVINDER
Middle Name:K
Last Name:MAKKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DEVINDER
Other - Middle Name:K
Other - Last Name:MAKKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:632 W 11TH ST
Mailing Address - Street 2:# 119
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376
Mailing Address - Country:US
Mailing Address - Phone:209-833-0272
Mailing Address - Fax:209-839-8473
Practice Address - Street 1:632 W 11TH ST
Practice Address - Street 2:# 119
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3856
Practice Address - Country:US
Practice Address - Phone:209-833-0272
Practice Address - Fax:209-839-8473
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A442150Medicaid
E98419Medicare UPIN
00A442151Medicare ID - Type Unspecified