Provider Demographics
NPI:1497705024
Name:EICHAS, KATY (PHYSICAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:EICHAS
Suffix:
Gender:F
Credentials:PHYSICAN ASSISTANT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:E
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6551 WILSON MILLS RD
Mailing Address - Street 2:#106
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3495
Mailing Address - Country:US
Mailing Address - Phone:440-449-8277
Mailing Address - Fax:440-449-7137
Practice Address - Street 1:6551 WILSON MILLS RD
Practice Address - Street 2:#106
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3495
Practice Address - Country:US
Practice Address - Phone:440-449-8277
Practice Address - Fax:440-449-7137
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002153363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ08210Medicare UPIN