Provider Demographics
NPI:1841287968
Name:MAKI, NEIL JAMES (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:JAMES
Last Name:MAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SAINT MARY ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2627
Mailing Address - Country:US
Mailing Address - Phone:985-446-6824
Mailing Address - Fax:
Practice Address - Street 1:525 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2627
Practice Address - Country:US
Practice Address - Phone:985-446-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.103892207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACJ6378OtherRAILROAD MEDICARE
LA1196151Medicaid
LA53352D244Medicare PIN
LAB64557Medicare UPIN