Provider Demographics
NPI:1366827271
Name:CAWTHON, MAKEBA
Entity type:Individual
Prefix:
First Name:MAKEBA
Middle Name:
Last Name:CAWTHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21941 PARKLAWN ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2687
Mailing Address - Country:US
Mailing Address - Phone:249-798-7671
Mailing Address - Fax:
Practice Address - Street 1:21941 PARKLAWN ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2687
Practice Address - Country:US
Practice Address - Phone:249-798-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker