Provider Demographics
NPI:1881083053
Name:RAMUS, MACKENZI E (PA-C)
Entity type:Individual
Prefix:
First Name:MACKENZI
Middle Name:E
Last Name:RAMUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MACKENZI
Other - Middle Name:E
Other - Last Name:BUCKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4912 HIGBEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2599
Mailing Address - Country:US
Mailing Address - Phone:330-492-0840
Mailing Address - Fax:330-492-0840
Practice Address - Street 1:4912 HIGBEE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2599
Practice Address - Country:US
Practice Address - Phone:330-492-2844
Practice Address - Fax:330-492-0840
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50004146363A00000X
OH50.002225-RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant