Provider Demographics
NPI:1538146725
Name:MCKENZIE, MICHAEL JOACHIM (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOACHIM
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4050 SHERIDAN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-889-0211
Mailing Address - Fax:954-889-0213
Practice Address - Street 1:200 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-362-8677
Practice Address - Fax:954-458-8167
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267823300Medicaid
FLH74083Medicare UPIN
FL267823300Medicaid