Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301050154 | MI |
NPI | 1043260102 |
---|---|
Provider Name | Dr. James R Mackenzie |
First Address | Traverse City, MI 49684-9200 |
Second Address | Traverse City, MI 49684-9200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 26/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4159010 | (05) | MI |
E49074 | (02) | MI |