MEDICARE: DR. SUSAN MCKINNEY M.D.

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	207R00000X	Internal Medicine Physician	J4341	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AG053	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194700542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MCKINNEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 678513
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-8513
Country	:	US
Telephone Number	:	972-284-7000
Fax Number	:	972-284-7001

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	SUITE 230
City	:	DALLAS
State	:	TX
Zip	:	75231-4405
Country	:	US
Telephone Number	:	972-284-7000
Fax Number	:	972-284-7001

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	01/04/2011

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