Healthcare Provider Details

I. General information

NPI: 1285829176
Provider Name (Legal Business Name): AINE P MCKENZIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AINE P O'BRIEN

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 W PLANO PKWY SUITE 100
PLANO TX
75093-5619
US

IV. Provider business mailing address

4031 W PLANO PKWY SUITE 100
PLANO TX
75093-5619
US

V. Phone/Fax

Practice location:
  • Phone: 972-985-1072
  • Fax: 972-596-5382
Mailing address:
  • Phone: 972-985-1072
  • Fax: 972-596-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM6284
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM6284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: