Provider Demographics
NPI:1770641417
Name:MAKEBA, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAKEBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 E LONG ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1835
Mailing Address - Country:US
Mailing Address - Phone:614-604-2899
Mailing Address - Fax:
Practice Address - Street 1:1005 E LONG ST
Practice Address - Street 2:SUITE 3
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1835
Practice Address - Country:US
Practice Address - Phone:614-604-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide