MEDICARE: DR. POLAWYN CLAIRE MCKINNEY MD

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
1	2084P0800X	Psychiatry Physician	N9602	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3864783216	OTHER		MYUTMB 3864783216

General Provider Information

NPI Number	:	1982895173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POLAWYN CLAIRE MCKINNEY MD

Provider Business Mailing Address
First Line	:	1631 E 2ND ST
Second Line	:	BUILDING D
City	:	AUSTIN
State	:	TX
Zip	:	78702-4490
Country	:	US
Telephone Number	:	512-472-4357
Fax Number	:	512-476-1469

Provider Business Practice Location Address
First Line	:	1631 E 2ND ST
Second Line	:	BUILDING D
City	:	AUSTIN
State	:	TX
Zip	:	78702-4490
Country	:	US
Telephone Number	:	512-472-4357
Fax Number	:	512-476-1469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	07/06/2011

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