MEDICARE: KATY EICHAS PHYSICAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	50.002153	OH

General Provider Information

NPI Number	:	1497705024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY EICHAS PHYSICAN ASSISTANT

Provider Business Mailing Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	#106
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-449-8277
Fax Number	:	440-449-7137

Provider Business Practice Location Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	#106
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-449-8277
Fax Number	:	440-449-7137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/13/2011

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