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General NPI Number Information
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NPI Number | 1942950969
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Entity Type | Individual
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Provider Name | MACKENZIE LINK
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Gender | Male
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 8745 N WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32940-5997
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Country | US
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Telephone | 321-837-3820
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 W EAU GALLIE BLVD STE 101
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City | MELBOURNE
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State | FL
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Zip | 32935-8303
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD.48042
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License Number State | AL
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