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General NPI Number Information
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NPI Number | 1598177461
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Entity Type | Individual
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Provider Name | TINA MCKENZIE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 07/27/2017
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Provider Practice Location Address
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Address Line | 950 E VAN BUREN ST
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City | AVONDALE
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State | AZ
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Zip | 85323-1506
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Country | US
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Telephone | 623-344-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 2929 E THOMAS
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City | PHOENIX
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State | AZ
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Zip | 85016
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Country | US
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Telephone | 602-470-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 54330
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License Number State | AZ
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