Provider Demographics
NPI:1366428328
Name:MAKKI, MOJGAN (MD)
Entity type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:MAKKI
Suffix:
Gender:F
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 4732
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4732
Mailing Address - Country:US
Mailing Address - Phone:314-324-4235
Mailing Address - Fax:773-536-2703
Practice Address - Street 1:4455 S KING DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3310
Practice Address - Country:US
Practice Address - Phone:314-324-4235
Practice Address - Fax:773-536-2703
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030317752084P0800X
IL0361241042084P0800X
ILDEA FM16757712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
188760OtherBLUE CROSS
703139OtherHEALTHLINK
MO209194125Medicaid
MO209194125Medicaid
188760OtherBLUE CROSS