Provider Demographics
NPI:1245399963
Name:MCKENZIE, WILFRED CLIFTON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:CLIFTON
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SOUTH EAST THIRD AVENUE
Mailing Address - Street 2:#400
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-832-0055
Mailing Address - Fax:954-832-0063
Practice Address - Street 1:1625 SOUTH EAST THIRD AVENUE
Practice Address - Street 2:#400
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-832-0055
Practice Address - Fax:954-832-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257017300Medicaid
FL371522100Medicaid
FL257017300Medicaid
FL14823Medicare ID - Type Unspecified
FL371522100Medicaid