Metropolitan
After completing his studies, Mar Makarios traveled back to India and took a position as a professor at Orthodox Theological Seminary teaching church history. He was elevated to the title of bishop in 1975 and was posted as the Metropolitan of the Bombay Diocese. He was the first Metropolitan of this area.
In 1979, Mar Makarios' presence was requested to help lead the newly formed American diocese as the Metropolitan of the American Diocese. He consecrated the first church of the diocese in 1980. During his office, he consecrated an additional 74 churches into the Indian Orthodox American Diocese. While holding his office as Metropolitan of the American Diocese, he began teaching religion at Alma College in Michigan. He continued teaching there as a visiting professor until his death.
In 1994, Mar Makarios' presence was again requested. This time it was to help guide the newly formed Diocese of Canada and Europe. Mar Makarios was anointed as the very first metropolitan of this new diocese as well.