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General NPI Number Information
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NPI Number | 1245266089
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Entity Type | Individual
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Provider Name | BENJAMIN IVAN MCKINNEY DPM
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 307 SOUTH MAIN ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-3815
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Country | US
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Telephone | 336-342-5701
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Fax | 336-342-1373
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Provider Business Mailing Address
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Address Line | 307 SOUTH MAIN ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-3815
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Country | US
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Telephone | 336-342-5701
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Fax | 336-342-1373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00290
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 557
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License Number State | NC
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