Provider Demographics
NPI:1952320368
Name:EICHENLAUB, MARK J (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:EICHENLAUB
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:224 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9658
Mailing Address - Country:US
Mailing Address - Phone:231-352-2285
Mailing Address - Fax:231-352-6141
Practice Address - Street 1:224 PARK AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9658
Practice Address - Country:US
Practice Address - Phone:231-352-2285
Practice Address - Fax:231-352-6141
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical