=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417627746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL J MCKENNA D.O. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2021
-----------------------------------------------------
Last Update Date | 07/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4970 N EXPRESSWAY STE A
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78526-4269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-621-4981
-----------------------------------------------------
Fax | 956-621-4994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4970 N EXPRESSWAY STE A
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78526-4269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-621-4981
-----------------------------------------------------
Fax | 956-621-4994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ZENAIDA TORRES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-621-4981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------