Healthcare Provider Details

I. General information

NPI: 1275595076
Provider Name (Legal Business Name): MARGARET GRANT MCKERNAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 PIIKOI ST APT 4405
HONOLULU HI
96814-4286
US

IV. Provider business mailing address

1820 PRESTON PARK BLVD 1825
PLANO TX
75093-5215
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax: 612-294-4903
Mailing address:
  • Phone: 972-867-7862
  • Fax: 972-612-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-13453
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: