Provider Demographics
NPI:1427168350
Name:MAKINDE, JOHN (DHSC, PAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MAKINDE
Suffix:
Gender:M
Credentials:DHSC, PAC
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 171692
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-1692
Mailing Address - Country:US
Mailing Address - Phone:817-874-3329
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD # 112A DEPT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1817
Practice Address - Fax:214-302-1306
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA06021OtherLICENSE