Provider Demographics
NPI:1205890654
Name:MACKENZIE, KAREN M (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:316 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6232
Mailing Address - Country:US
Mailing Address - Phone:559-733-9900
Mailing Address - Fax:559-733-9903
Practice Address - Street 1:316 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6232
Practice Address - Country:US
Practice Address - Phone:559-733-9900
Practice Address - Fax:559-733-9903
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85141208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H24305Medicare UPIN
FL37956ZMedicare ID - Type Unspecified