Active NPI
Amy L McKenzie, MD
- Specialist
- Clinton Township, MI
National Provider Identifier
1083657894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- AM069839
- Practice address
- 15501 Metropolitan Pkwy
Ste 110
Clinton Township, MI 48036-1684 - Phone
- (586) 286-9720
- Fax
- (586) 286-3134
- NPI assigned
- Jun 13, 2006
- Last updated
- Feb 3, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | AM069839 | MI | Primary |
Addresses
Primary practice location
15501 Metropolitan Pkwy
Ste 110
Clinton Township, MI 48036-1684
Mailing address
15501 Metropolitan Pkwy
Ste 110
Clinton TWP, MI 48036-1684
Phone (586) 286-9720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0501612 | Other | MI | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AM069839 | MI | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Doctors | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1093928970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233619200000",
"number": "1083657894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15501 METROPOLITAN PKWY",
"address_2": "STE 110",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480361684",
"telephone_number": "586-286-9720",
"fax_number": "586-286-3134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15501 METROPOLITAN PKWY",
"address_2": "STE 110",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480361684",
"telephone_number": "586-286-9720",
"fax_number": "586-286-3134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENZIE",
"first_name": "AMY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-13",
"last_updated": "2009-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MI",
"license": "AM069839",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0501612",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.