Provider Demographics
NPI:1205602208
Name:ALMAKKY, MOHAMAD ABDULLGHANI
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:ABDULLGHANI
Last Name:ALMAKKY
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 1:3507 GRACELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208
Mailing Address - Country:US
Mailing Address - Phone:330-906-2621
Mailing Address - Fax:
Practice Address - Street 1:24007 MERRLYN CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-2333
Practice Address - Country:US
Practice Address - Phone:317-645-6146
Practice Address - Fax:317-204-8787
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical