Individual
MIGNON M MAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401
(573) 364-9000
(816) 364-3894
Mailing address
PO BOX 579, ROLLA, MO 65402
(816) 364-3834
(816) 364-3894
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
R2F40
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202550208
—
MO
Enumeration date
08/26/2005
Last updated
08/22/2019
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