Healthcare Provider Details

I. General information

NPI: 1750709150
Provider Name (Legal Business Name): KRISTEN EICHORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 TYLER BLVD STE 300
MENTOR OH
44060-4251
US

IV. Provider business mailing address

8030 LAKE WOOD DR
PORTAGE MI
49002-5565
US

V. Phone/Fax

Practice location:
  • Phone: 440-357-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.133404
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: