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NPI Code Detail

MEDICARE: BRIAN J MCKEON PA

MEDICARE: BRIAN J MCKEON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363A00000XPhysician Assistant5601002739MI
3363AM0700XMedical Physician Assistant
4363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1356397632
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN J MCKEON PA
Provider Business Mailing Address
First Line : 3621 S STATE ST
Second Line : 700 KMS PLACE
City : ANN ARBOR
State : MI
Zip : 48108
Country : US
Telephone Number : 734-936-2047
Fax Number :
Provider Business Practice Location Address
First Line : 1500 EAST MEDICAL CENTER DR
Second Line : 3RD FLOOR CARDIOVASCULAR CENTER
City : ANN ARBOR
State : MI
Zip : 48109-5856
Country : US
Telephone Number : 888-287-1082
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 10/21/2008

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