Basic Information
| Provider Information | |||||||||
| NPI: | 1508930173 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAK HEALTHCARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 ERDMAN ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180132043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105882225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 ERDMAN ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180132043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105882225 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 10/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | MAGDIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6105882225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 363LP2300X | PA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50031706 | 01 | PA | CAPITAL BC | OTHER | MA1785117 | 01 | PA | HIGHMARK-MEDICAL | OTHER | 3919243 | 01 | PA | AETNA | OTHER | 1508930173 | 01 | PA | RAILROAD MEDICARE/PALMETT | OTHER | 660979 | 01 | PA | UNITED HC | OTHER | P38305 | 01 | PA | AMERIHEALTH | OTHER | MT1552791 | 01 | PA | HIGHMARK-CHIROPRACTIC | OTHER | 2626451000 | 01 | PA | PERSONAL CHOICE | OTHER |