Individual
MACKENZIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
920 E 28TH ST, SUITE 460, MINNEAPOLIS, MN 55407-1286
(612) 863-7770
Mailing address
2925 CHICAGO AVENUE, MINNEAPOLIS, MN 55407-1321
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
66100
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2016
Last updated
09/07/2023
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