Provider Demographics
NPI:1669541991
Name:MCKENZIE, KAY Q (MD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:Q
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAY
Other - Middle Name:Q
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1611 SO GREEN RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4192
Mailing Address - Country:US
Mailing Address - Phone:216-691-9420
Mailing Address - Fax:216-297-3161
Practice Address - Street 1:1611 SO GREEN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-4192
Practice Address - Country:US
Practice Address - Phone:216-691-9420
Practice Address - Fax:216-297-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350385482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373706Medicaid
A77752Medicare UPIN
MC0451211Medicare ID - Type Unspecified
OH0373706Medicaid