Provider Demographics
NPI:1154513661
Name:MCKENZIE, JILL J (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:J
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S DOBSON RD
Mailing Address - Street 2:223
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6157
Mailing Address - Country:US
Mailing Address - Phone:480-821-8888
Mailing Address - Fax:480-821-0888
Practice Address - Street 1:1100 S DOBSON RD
Practice Address - Street 2:223
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6157
Practice Address - Country:US
Practice Address - Phone:480-821-8888
Practice Address - Fax:480-821-0888
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44537207ND0101X, 207N00000X, 207ND0101X
UT13534965-1205207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146137Medicare PIN
AZ761835OtherAZ MEDICAL NETWORK
AZ631319Medicaid
AZ631319OtherAHCCCS
AZ9774656OtherAETNA
AZP00965749OtherRAILROAD MEDICARE
AZ3329203OtherUNITED HEALTHCARE
AZ3Z2437OtherHEALTH NET