Individual
MACKENZIE T WORTHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3505 N BELL SCHOOL RD, ROCKFORD, IL 61114-6624
(779) 696-0300
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036144076
IL
207Q00000X
Family Medicine Physician
R9738
IA
Other
Enumeration date
07/08/2013
Last updated
03/26/2021
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