Provider Demographics
NPI:1306910732
Name:ERNEST MAK MD PC
Entity type:Organization
Organization Name:ERNEST MAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-815-8300
Mailing Address - Street 1:1589 SPARTA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1390
Mailing Address - Country:US
Mailing Address - Phone:931-815-8300
Mailing Address - Fax:
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1390
Practice Address - Country:US
Practice Address - Phone:931-815-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41742207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty