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NPI Code Detail

MEDICARE: MICHELLE M MCKANE MD

MEDICARE:   MICHELLE M MCKANE  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
1208000000XPediatrics PhysicianM3640TX
2207P00000XEmergency Medicine PhysicianM3640TX

General Provider Information

NPI Number : 1255363099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE M MCKANE MD
Provider Business Mailing Address
First Line : PO BOX 99213
Second Line :
City : FORT WORTH
State : TX
Zip : 76199-0213
Country : US
Telephone Number : 682-885-4871
Fax Number : 682-885-3936
Provider Business Practice Location Address
First Line : 2727 E SOUTHLAKE BLVD
Second Line :
City : SOUTHLAKE
State : TX
Zip : 76092-6613
Country : US
Telephone Number : 682-885-6000
Fax Number : 682-885-6050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 01/12/2012

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Directions to “ MICHELLE M MCKANE MD” Practice Location

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