Provider Demographics
NPI:1992412134
Name:OLRICH, MAKENZIE RAE (PA)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:RAE
Last Name:OLRICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1903
Mailing Address - Country:US
Mailing Address - Phone:517-784-9189
Mailing Address - Fax:517-780-9239
Practice Address - Street 1:214 N WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1903
Practice Address - Country:US
Practice Address - Phone:517-784-9189
Practice Address - Fax:517-780-9239
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine