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Contact Information

EILEEN L AXIBAL, MD
1740 E PARIS AVE SE
GRAND RAPIDS, MI49546-6204
 Phone: 616-949-5600
 Fax: 616-949-6571
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
 

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for EILEEN L AXIBAL · (Female)

NPI Number 1154732386
Status Active
Credentials MD
Entity Individual
Enumeration date 05/09/2014
Last updated 01/10/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 021728
  • MI License # 4301502472
  • NC License # 2019-00214
  • SC License # 82323
Hospital affiliation(s)
  • SPECTRUM HEALTH - BUTTERWORTH CAMPUS - (Acute Care)
    100 MICHIGAN ST NE
    GRAND RAPIDS, MI 49503
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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