Provider Demographics
NPI:1285829176
Name:MCKENZIE, AINE P (MD)
Entity Type:Individual
Prefix:
First Name:AINE
Middle Name:P
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AINE
Other - Middle Name:P
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4031 W PLANO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5619
Mailing Address - Country:US
Mailing Address - Phone:972-985-1072
Mailing Address - Fax:972-596-5382
Practice Address - Street 1:4031 W PLANO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5619
Practice Address - Country:US
Practice Address - Phone:972-985-1072
Practice Address - Fax:972-596-5382
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6284208100000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CR154OtherBCBS TX 02/01/2011
TXM6284OtherTEXAS MEDICAL BOARD
TXTXB117532OtherMEDICARE PART B - EFFECT 02/01/2011
TXP00913355OtherMEDICARE RAILROAD - EFFECT 02/01/2011
TX6484850002Medicare NSC
TX8CR154OtherBCBS TX 02/01/2011
TX8K2698Medicare PIN