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General NPI Number Information
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NPI Number | 1841577541
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Entity Type | Organization
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Legal Business Name | MCKINNON MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 2400 S CIMARRON RD STE 120
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City | LAS VEGAS
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State | NV
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Zip | 89117-7902
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Country | US
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Telephone | 702-505-4230
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Fax |
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Provider Business Mailing Address
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Address Line | 7575 W WASHINGTON AVE STE 127-160
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City | LAS VEGAS
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State | NV
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Zip | 89128-4333
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Country | US
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Telephone | 702-505-4230
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JONATHAN MCKINNON
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Credential | MD
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Telephone | 702-256-3637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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