Provider Demographics
NPI:1962259309
Name:STINE, MCKENZIE RENEE (DO)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:RENEE
Last Name:STINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1872
Mailing Address - Country:US
Mailing Address - Phone:419-341-6236
Mailing Address - Fax:
Practice Address - Street 1:14601 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4205
Practice Address - Country:US
Practice Address - Phone:216-237-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program