Individual
MACKENZIE L EITER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1205 S MAIN ST STE 101, CROWN POINT, IN 46307-3677
(219) 662-0077
(219) 662-6701
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003365A
IN
Other
Enumeration date
02/10/2020
Last updated
06/05/2023
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