| Doctor Name: | MR. KEVIN MICHAEL MCKENZIE |
| NPI Number: | 1275678732 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAT, LPTA |
| License Number: | J3-0000118 |
| Business Practice Address: | 2813 W 17th St Wilmington, DE - 198061112 |
| Business Phone Number: | 3027220406 |
| Business Fax Number: | |
| Mailing Address: | 1319 Woodlawn Ave, WILMINGTON |
| State: | DE |
| Postal Code: | 198062445 |
| Phone Number: | 3025750550 |
| Fax Number: | 3026578373 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | J3-0000118 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | DE |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |