MEDICARE: KAREN L MACKENZIE MD

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	207Q00000X	Family Medicine Physician	25359	MN

General Provider Information

NPI Number	:	1396711628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN L MACKENZIE MD

Provider Business Mailing Address
First Line	:	8100 34TH AVE S
Second Line	:	MAIL STOP 21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1672
Country	:	US
Telephone Number	:	952-883-5463
Fax Number	:	952-883-5395

Provider Business Practice Location Address
First Line	:	2831 SNELLING AVE N
Second Line	:	MAIL STOP 39601A
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2460
Country	:	US
Telephone Number	:	651-636-4525
Fax Number	:	651-636-7427

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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