Healthcare Provider Details

I. General information

NPI: 1316649882
Provider Name (Legal Business Name): MCKENZIE CHAMBERLAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 E JEFFERSON AVE
DETROIT MI
48207-4236
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-1600
  • Fax:
Mailing address:
  • Phone: 586-777-2050
  • Fax: 586-777-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301518108
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301518108
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: