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General NPI Number Information
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NPI Number | 1962646604
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Entity Type | Organization
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Legal Business Name | COLIN N MACKENZIE MD LC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 11011 KING ST SUITE 260
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City | OVERLAND PARK
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State | KS
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Zip | 66210-1213
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Country | US
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Telephone | 913-642-3134
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Fax | 913-766-6037
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Provider Business Mailing Address
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Address Line | 11011 KING ST SUITE 260
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City | OVERLAND PARK
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State | KS
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Zip | 66210-1213
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Country | US
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Telephone | 913-642-3134
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Fax | 913-766-6037
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. COLIN NEIL MACKENZIE
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Credential | M.D.
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Telephone | 913-642-3134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 30842
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License Number State | KS
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