Provider Demographics
NPI:1942569231
Name:GOODWIN, MACKENZIE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:LEE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MACKENZIE
Other - Middle Name:LEE
Other - Last Name:BEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2101
Mailing Address - Fax:614-293-9155
Practice Address - Street 1:1581 DODD DR FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1257
Practice Address - Country:US
Practice Address - Phone:614-293-2101
Practice Address - Fax:614-293-9155
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351368662086S0102X
UT11768709-12052086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0365561Medicaid