Provider Demographics
NPI:1891973608
Name:VARKULA, MACKENZIE (DO)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:
Last Name:VARKULA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18101 LORAIN AVE
Mailing Address - Street 2:PPSY
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5612
Mailing Address - Country:US
Mailing Address - Phone:216-476-6958
Mailing Address - Fax:216-476-4845
Practice Address - Street 1:18101 LORAIN AVE
Practice Address - Street 2:PPSY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-6958
Practice Address - Fax:216-476-4845
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0096232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry