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General NPI Number Information
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NPI Number | 1447663190
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Entity Type | Individual
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Provider Name | DR. PATRICIA MCKIE
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Gender | Female
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 3204 LANCER ST STE A
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City | PORTAGE
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State | IN
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Zip | 46368-4491
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Country | US
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Telephone | 219-762-5506
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 LANCER ST STE A
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City | PORTAGE
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State | IN
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Zip | 46368-4491
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Country | US
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Telephone | 219-762-5506
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN22777
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DT-2608
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12012143A
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License Number State | IN
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