Provider Demographics
NPI:1336567536
Name:MCKENZIE, SHEENA GUPTA (MD, MBA)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:GUPTA
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2833
Mailing Address - Fax:
Practice Address - Street 1:777 PARK AVE. WEST
Practice Address - Street 2:PEDIATRIC HOSPITALISTS
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2433
Practice Address - Country:US
Practice Address - Phone:847-570-2530
Practice Address - Fax:847-570-0231
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036150397208000000X, 208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist