MEDICARE: MR. DONALD HUGH MCKENZIE JR. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50-002510	OH
2	363A00000X	Physician Assistant	01073032A	IN
3	363A00000X	Physician Assistant	10001943A	IN
4	363AM0700X	Medical Physician Assistant	TC-029	KY
5	363A00000X	Physician Assistant	PA1134	KY

General Provider Information

NPI Number	:	1003898214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD HUGH MCKENZIE JR. P.A.

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	859-334-8700
Fax Number	:	859-334-8707

Provider Business Practice Location Address
First Line	:	1980 LITTON LANE
Second Line	:
City	:	HEBRON
State	:	KY
Zip	:	41048-8669
Country	:	US
Telephone Number	:	859-334-8700
Fax Number	:	859-334-8707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/24/2023

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