MEDICARE: KENZI MEDSPA AND WELLNESS CENTER

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	261Q00000X	Clinic/Center
2	207QA0505X	Adult Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306314216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENZI MEDSPA AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	900 6TH AVE S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6745
Country	:	US
Telephone Number	:	239-529-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 6TH AVE S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6745
Country	:	US
Telephone Number	:	239-529-2864
Fax Number	:	800-877-6470

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ALDENE MCKENZIE
Credential	:	DO
Telephone Number	:	239-529-2864

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	08/09/2022

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Directions to “KENZI MEDSPA AND WELLNESS CENTER ” Practice Location

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