Provider Demographics
NPI:1750489589
Name:MAK, ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:MAK
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 1:1803 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-8998
Mailing Address - Country:US
Mailing Address - Phone:870-816-3800
Mailing Address - Fax:870-816-3801
Practice Address - Street 1:1803 MARTIN LUTHER KING JR DR
Practice Address - Street 2:SUITE D
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-8998
Practice Address - Country:US
Practice Address - Phone:870-816-3800
Practice Address - Fax:870-816-3801
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41742207V00000X
ARE-0301207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN300002401Medicaid
TN300002401Medicare PIN