Healthcare Provider Details

I. General information

NPI: 1558364471
Provider Name (Legal Business Name): THOMAS CONDON MCKAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 SPRING ST
DAVENPORT IA
52807-2125
US

IV. Provider business mailing address

3319 SPRING ST
DAVENPORT IA
52807-2125
US

V. Phone/Fax

Practice location:
  • Phone: 563-359-1641
  • Fax: 563-359-4634
Mailing address:
  • Phone: 563-359-1641
  • Fax: 563-359-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036085709
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number29811
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: