Provider Demographics
NPI:1689750465
Name:MAKELA, PAUL I (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MAKELA
Suffix:I
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 1:3011 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
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056367207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4854371-10Medicaid
F81556Medicare UPIN
0P00120Medicare ID - Type Unspecified