Individual
DOUGLAS MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1060
(906) 483-1066
Mailing address
301 EXPLORER ST, GWINN, MI 49841-2813
(906) 346-4924
(906) 346-6474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301053781
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0829560001
MEDICARE DME
MI
01
—
0C16002
MEDICARE GROUP
MI
05
—
103097998
—
MI
01
—
DM053781
BLUECROSS STATE ID
MI
Enumeration date
08/15/2006
Last updated
04/14/2021
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