Healthcare Provider Details

I. General information

NPI: 1164054169
Provider Name (Legal Business Name): MCKENZIE INSTITUTE FOR FOOT & ANKLE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 BRIDGE RD STE 101
SUFFOLK VA
23435-1133
US

IV. Provider business mailing address

3907 BRIDGE RD STE 101
SUFFOLK VA
23435-1133
US

V. Phone/Fax

Practice location:
  • Phone: 757-977-1026
  • Fax: 757-977-1027
Mailing address:
  • Phone: 757-977-1026
  • Fax: 757-977-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER MARIE MCKENZIE
Title or Position: PHYSICIAN
Credential: MD
Phone: 757-977-1026