Healthcare Provider Details

I. General information

NPI: 1215911201
Provider Name (Legal Business Name): DANIEL W MCKENNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 320
INDIANAPOLIS IN
46260-2052
US

IV. Provider business mailing address

8402 HARCOURT RD STE 320
INDIANAPOLIS IN
46260-2052
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-2487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37943
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number37943
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number01062203A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: