Provider Demographics
NPI:1316530868
Name:MCKENZIE, IAN DUNCAN (RDN)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:DUNCAN
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 S HOLLISTER RD
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:MI
Mailing Address - Zip Code:48866-8622
Mailing Address - Country:US
Mailing Address - Phone:989-627-6152
Mailing Address - Fax:
Practice Address - Street 1:3341 S HOLLISTER RD
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-8622
Practice Address - Country:US
Practice Address - Phone:989-627-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86116311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered