Healthcare Provider Details

I. General information

NPI: 1962793497
Provider Name (Legal Business Name): KEVIN P MCKENZIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 BATES AVE STE 630
HOUSTON TX
77030-2623
US

IV. Provider business mailing address

1102 BATES AVE STE 630
HOUSTON TX
77030-2623
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-1038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0000054140
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: