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Individual
TERESA MCKENZIE
Active
Individual
TERESA MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036076673
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076673
—
IL
01
—
1639941
BCBS
IL
01
—
208524
MEDICARE
IL
Enumeration date
06/21/2006
Last updated
01/15/2013
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