Individual
MACKENZY LEE KASSAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
31393 W 13 MILE RD STE 105, FARMINGTON HILLS, MI 48334-2232
(734) 331-6037
Mailing address
4421 FOREST HILL DR, COMMERCE TOWNSHIP, MI 48382-1591
(248) 412-3120
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011399
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601011399
MI PHYSICIAN ASSISTANT LICENSE
MI
Enumeration date
08/08/2022
Last updated
03/26/2025
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