Healthcare Provider Details

I. General information

NPI: 1366488033
Provider Name (Legal Business Name): TERESA MCKENZIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA MCKENZIE-LANDGREN MD

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 1/2 NORTH AVE
RIVER FOREST IL
60305-1133
US

IV. Provider business mailing address

7605 1/2 NORTH AVE
RIVER FOREST IL
60305-1133
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-4888
  • Fax: 708-366-7510
Mailing address:
  • Phone: 708-366-4888
  • Fax: 708-366-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036076673
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: