Individual
MACKENZIE ROBERT FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
18181 OAKWOOD BLVD STE 401, DEARBORN, MI 48124-5031
(313) 593-7240
(313) 593-8899
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5101027950
MI
Other
Enumeration date
04/29/2021
Last updated
08/05/2025
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