Healthcare Provider Details

I. General information

NPI: 1831124031
Provider Name (Legal Business Name): ALEXANDER M MCKINNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 NW 14TH ST STE 511
MIAMI FL
33136-2111
US

IV. Provider business mailing address

1150 NW 14TH ST
MIAMI FL
33136-2137
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6164
  • Fax:
Mailing address:
  • Phone: 305-243-1759
  • Fax: 305-243-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number44222
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number145792
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number44222
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number145792
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME145792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: