Provider Demographics
NPI:1720268030
Name:KS MAKKI PC
Entity Type:Organization
Organization Name:KS MAKKI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KHOSROW
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-345-5877
Mailing Address - Street 1:7247 HANOVER PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3661
Mailing Address - Country:US
Mailing Address - Phone:301-345-5877
Mailing Address - Fax:
Practice Address - Street 1:7247 HANOVER PKWY
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3661
Practice Address - Country:US
Practice Address - Phone:301-345-5877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30607207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCY32976Medicare UPIN
DCG01962Medicare PIN