Provider Demographics
NPI:1104906999
Name:MAKRIS, NICHOLAOS GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAOS
Middle Name:GEORGE
Last Name:MAKRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICHOLAOS
Other - Middle Name:GEORGE
Other - Last Name:MAKRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:15590 WEST THIRTEEN MILE ROAD SUITE B
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-723-5600
Mailing Address - Fax:248-723-5266
Practice Address - Street 1:15590 WEST THIRTEEN MILE ROAD SUITE B
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-723-5600
Practice Address - Fax:248-723-5266
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINM032021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0635309Medicare ID - Type Unspecified
A77454Medicare UPIN