Provider Demographics
NPI:1881031276
Name:MCKENZIE, EMILY CAROLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:CAROLYN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:CAROLYN
Other - Last Name:GRAUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST
Mailing Address - Street 2:SUITE A3K00
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:502-852-7040
Mailing Address - Fax:502-852-8980
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:SUITE A3K00
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-852-7040
Practice Address - Fax:502-852-8980
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT10239407-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program