Provider Demographics
NPI:1548251168
Name:MACKENZIE, JAMES C (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1380 COOLIDGE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7018
Mailing Address - Country:US
Mailing Address - Phone:248-288-4000
Mailing Address - Fax:248-288-3900
Practice Address - Street 1:1380 COOLIDGE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7018
Practice Address - Country:US
Practice Address - Phone:248-288-4000
Practice Address - Fax:248-288-3900
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301030901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B44682Medicare UPIN
2637950Medicare ID - Type Unspecified