Provider Demographics
NPI:1760018808
Name:MACKMIN, RACHEL RENEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:RENEE
Last Name:MACKMIN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:43475 DALCOMA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3593
Mailing Address - Country:US
Mailing Address - Phone:586-321-1139
Mailing Address - Fax:
Practice Address - Street 1:43475 DALCOMA DR STE 200
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3593
Practice Address - Country:US
Practice Address - Phone:865-228-2518
Practice Address - Fax:586-228-2517
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601009986363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty