Basic Information
| Provider Information | |||||||||
| NPI: | 1245214196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAKWANA | ||||||||
| FirstName: | HEMRAJ | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 5TH ST N | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397052248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192315091 | ||||||||
| FaxNumber: | 6143868006 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 LINCOLNWAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463503429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193240014 | ||||||||
| FaxNumber: | 2193240025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 25736 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 01084129A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 08558360 | 05 | MS | MEDICAID |