Provider Demographics
NPI:1699797936
Name:MLCAK, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:MLCAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7217 TELECOM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2203
Mailing Address - Country:US
Mailing Address - Phone:469-800-2100
Mailing Address - Fax:469-800-2310
Practice Address - Street 1:7217 TELECOM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2203
Practice Address - Country:US
Practice Address - Phone:469-800-2100
Practice Address - Fax:469-800-2310
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG3618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133740406Medicaid
TX080086246OtherRR MEDICARE
TX87W713Medicare ID - Type Unspecified
TXB24942Medicare UPIN