Healthcare Provider Details

I. General information

NPI: 1992457709
Provider Name (Legal Business Name): MEGAN NICOLE EEKHOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

40777 ANN ARBOR RD E
PLYMOUTH MI
48170-4448
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: