Healthcare Provider Details

I. General information

NPI: 1831443761
Provider Name (Legal Business Name): MCKENZIE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N DELAWARE ST
SANDUSKY MI
48471-1009
US

IV. Provider business mailing address

120 N DELAWARE ST
SANDUSKY MI
48471-1009
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-6162
  • Fax: 810-648-5058
Mailing address:
  • Phone: 810-648-6162
  • Fax: 810-648-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY RUEDISUELI
Title or Position: V.P. OF FINANCE
Credential:
Phone: 810-648-6162