Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 21047 | WI |
NPI | 1033227301 |
---|---|
Provider Name | Alan K Mckenzie |
First Address | Marshfield, WI 54449-5777 |
Second Address | Marshfield, WI 54449-5777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30115200 | (05) | WI |
B54965 | (02) |