Provider Demographics
NPI:1033141478
Name:KENZIK, MARK ANTHONY (MA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:KENZIK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 BREVARD RD.
Mailing Address - Street 2:LAUREL PARK SHOPPING CENTER
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791
Mailing Address - Country:US
Mailing Address - Phone:828-696-8272
Mailing Address - Fax:828-696-8790
Practice Address - Street 1:1727 BREVARD RD.
Practice Address - Street 2:LAUREL PARK SHOPPING CENTER
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791
Practice Address - Country:US
Practice Address - Phone:828-696-8272
Practice Address - Fax:828-696-8790
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC801237600000X
NC417237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
P40142Medicare UPIN
NC2520993AMedicare PIN