Provider Demographics
NPI:1770805061
Name:MAKI, STEVEN J
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MAKI
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 1:322 FRONT AVE SW STE 29
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-6429
Mailing Address - Country:US
Mailing Address - Phone:616-401-1909
Mailing Address - Fax:
Practice Address - Street 1:322 FRONT AVE SW STE 29
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-6429
Practice Address - Country:US
Practice Address - Phone:616-401-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor