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1033167101

NPI Code Detail

MEDICARE: SARAH J MCKENNA MD

MEDICARE: SARAH J MCKENNA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	01061290A	IN
2	208000000X	Pediatrics Physician	01061290A	IN
3	207R00000X	Internal Medicine Physician	01061290A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	068010957	OTHER	IN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1102489411	OTHER	IN	ANTHEM PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033167101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH J MCKENNA MD

Provider Business Mailing Address
First Line	:	PO BOX 78158
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-0158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-3318
Country	:	US
Telephone Number	:	317-554-5300
Fax Number	:	317-554-5247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/07/2024

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Directions to “ SARAH J MCKENNA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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