Basic Information
| Provider Information | |||||||||
| NPI: | 1881031276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | CAROLYN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GRAUEL | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | CAROLYN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 550 S JACKSON ST | ||||||||
| Address2: | SUITE A3K00 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028527040 | ||||||||
| FaxNumber: | 5028528980 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S JACKSON ST | ||||||||
| Address2: | SUITE A3K00 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028527040 | ||||||||
| FaxNumber: | 5028528980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2013 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | 10239407-1205 | UT | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.