Provider Demographics
NPI:1144889544
Name:BREKKEN, MCKENZIE (DO)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:BREKKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-7766
Mailing Address - Fax:641-428-7788
Practice Address - Street 1:1410 6TH AVE S
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2606
Practice Address - Country:US
Practice Address - Phone:641-357-2191
Practice Address - Fax:641-357-6020
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-11628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine