Healthcare Provider Details

I. General information

NPI: 1720094089
Provider Name (Legal Business Name): MATTHEW J MCKENZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

IV. Provider business mailing address

2120 LIVE STRONGER ST
TEA SD
57064-8331
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5890
  • Fax:
Mailing address:
  • Phone: 605-331-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35462
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5001
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: