Healthcare Provider Details

I. General information

NPI: 1942950969
Provider Name (Legal Business Name): MACKENZIE LINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 N WICKHAM RD
MELBOURNE FL
32940-5997
US

IV. Provider business mailing address

2627 W EAU GALLIE BLVD STE 101
MELBOURNE FL
32935-8303
US

V. Phone/Fax

Practice location:
  • Phone: 321-837-3820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.48042
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: