Provider Demographics
NPI:1316052178
Name:MACKENZIE, COLIN NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:NEIL
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7866
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-0866
Mailing Address - Country:US
Mailing Address - Phone:913-766-7246
Mailing Address - Fax:913-766-7247
Practice Address - Street 1:400 E RED BRIDGE RD
Practice Address - Street 2:STE 302
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4031
Practice Address - Country:US
Practice Address - Phone:913-766-7246
Practice Address - Fax:913-766-7247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS308422084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205383318Medicaid
KS200367060AMedicaid