Healthcare Provider Details

I. General information

NPI: 1285029694
Provider Name (Legal Business Name): ALEXANDER MCKANNA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N WALNUT ST
ITASCA IL
60143
US

IV. Provider business mailing address

555 31ST ST
DOWNERS GROVE IL
60515-1235
US

V. Phone/Fax

Practice location:
  • Phone: 630-773-2478
  • Fax: 630-773-3695
Mailing address:
  • Phone: 219-836-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005795
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: