MEDICARE: ROYAL D 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	207RS0010X	Sports Medicine (Internal Medicine) Physician	036153421	IL
2	207Q00000X	Family Medicine Physician	036153421	IL

General Provider Information

NPI Number	:	1043730344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROYAL D MCKENNA MD

Provider Business Mailing Address
First Line	:	PO BOX 746715
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6715
Country	:	US
Telephone Number	:	773-352-1515
Fax Number	:	312-929-0373

Provider Business Practice Location Address
First Line	:	1625 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4303
Country	:	US
Telephone Number	:	708-312-0360
Fax Number	:

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

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	11/10/2025

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