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Search › Illinois › 183500000X

Jerold Mckenzie

NPI 1821574823 · on the registry since 2018 · sole proprietor

Practice

Address
4860 Hononegah Rd
Roscoe, IL 61073
Phone
(815) 623-7798
Fax
(815) 623-9479
Organisation at this address
Kroger Limited Partnership I
Inferred from a shared address, not stated in the registry.
Clinicians at this address
2

Registry record

Primary taxonomy
183500000X
183500000X
Also registered as
333600000X
Licence states on file
IL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2018-07-13

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois