Provider Demographics
NPI:1801898473
Name:MAKIM, JAYESH (MD)
Entity type:Individual
Prefix:DR
First Name:JAYESH
Middle Name:
Last Name:MAKIM
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:PO BOX 241889
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1889
Mailing Address - Country:US
Mailing Address - Phone:907-563-1777
Mailing Address - Fax:907-561-7464
Practice Address - Street 1:3650 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5207
Practice Address - Country:US
Practice Address - Phone:907-561-1565
Practice Address - Fax:907-561-1541
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD00643Medicaid
AK0185721OtherWA DEPT L&I
AK0185721OtherWA DEPT L&I
AK160109Medicare ID - Type UnspecifiedNORIDIAN MEDICARE