| Mkram, Inc. | |
|
614 Dalworth St Grand Prairie TX 75050-5504 | |
| (972) 264-9111 | |
| (972) 264-9120 |
| Full Name | Mkram, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 614 Dalworth St, Grand Prairie, Texas |
| Authorized Official Name and Position | Martin Kram (PRESIDENT) |
| Authorized Official Contact | 9722649111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mkram, Inc. 614 Dalworth St Grand Prairie TX 75050-5504 Ph: (972) 264-9111 | Mkram, Inc. 614 Dalworth St Grand Prairie TX 75050-5504 Ph: (972) 264-9111 |
| NPI Number | 1043582364 |
|---|---|
| Provider Enumeration Date | 02/01/2012 |
| Last Update Date | 04/01/2021 |
| Certification Date | 04/01/2021 |
| Medicare PECOS PAC ID | 9335307289 |
|---|---|
| Medicare Enrollment ID | O20120222001101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043582364 | NPI | - | NPPES |
| 145232804 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | K5593 (Texas) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Martin Kram |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760493555 PECOS PAC ID: 4284623109 Enrollment ID: I20040506001703 |
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