Provider Demographics
NPI:1710478573
Name:MACKENZIE, ETHAN LAGHI (MD)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:LAGHI
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8566
Mailing Address - Fax:614-293-3381
Practice Address - Street 1:915 OLENTANGY RIVER RD STE 2140
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-293-8566
Practice Address - Fax:614-293-3381
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2024-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.150824208200000X, 208200000X
WI73015-20208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery