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Individual

DR. EILEEN LARKIN AXIBAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1740 E PARIS AVE SE, GRAND RAPIDS, MI 49546-6204
(616) 949-5600
(616) 949-6571
Mailing address
1740 E PARIS AVE SE, GRAND RAPIDS, MI 49546-6204
(616) 949-5600
(616) 949-6571

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
021728
CO
207ND0101X
MOHS-Micrographic Surgery Physician
2019-00214
NC
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
4301502472
MI
207ND0101X
MOHS-Micrographic Surgery Physician
82323
SC

Other

Enumeration date
05/09/2014
Last updated
01/10/2024
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