Provider Demographics
NPI:1104578368
Name:MKL CO
Entity type:Organization
Organization Name:MKL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:734-887-6027
Mailing Address - Street 1:2010 HOGBACK RD STE 6F
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-8800
Mailing Address - Country:US
Mailing Address - Phone:734-887-6027
Mailing Address - Fax:248-742-8088
Practice Address - Street 1:2010 HOGBACK RD STE 6F
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-8800
Practice Address - Country:US
Practice Address - Phone:734-887-6027
Practice Address - Fax:248-742-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty