Healthcare Provider Details

I. General information

NPI: 1922113604
Provider Name (Legal Business Name): MICHELE ROSE MCKEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON STREET CCMC DIVISION OF EMERGENCY MEDICINE
HARTFORD CT
06106
US

IV. Provider business mailing address

10 COLUMBUS BLVD FL 4
HARTFORD CT
06106-1976
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9000
  • Fax:
Mailing address:
  • Phone: 860-837-6929
  • Fax: 860-837-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number64696
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number80718
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: