Provider Demographics
NPI:1548331689
Name:MAKUTA, RONALD JAMES (DPM)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:MAKUTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BROOKHILL RD
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-1045
Mailing Address - Country:US
Mailing Address - Phone:570-788-2776
Mailing Address - Fax:570-788-5049
Practice Address - Street 1:2 BROOKHILL RD
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-1045
Practice Address - Country:US
Practice Address - Phone:570-788-2776
Practice Address - Fax:570-788-5049
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC 002077 L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50002755OtherCAPITAL BLUE CROSS
PA442480019OtherRAILROAD MEDICARE
PAMA93115OtherHIGHMARK BLUE SHIELD
PAT72728Medicare UPIN
PA093115Medicare ID - Type Unspecified
PA50002755OtherCAPITAL BLUE CROSS