MEDICARE: DR. DANIEL 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	207Y00000X	Otolaryngology Physician	ME86932	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	216438	OTHER	FL	WELLCARE (MEDICARE/MEDICAID)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P952222	OTHER	FL	OPTIMUM
2	P305695	OTHER	FL	FREEDOM HEALTH
3	79175	OTHER	FL	BCBS OF FL
4	8379386	OTHER	FL	CIGNA
5	289239	OTHER	FL	AVMED
7	P01283323	OTHER	FL	RAILROAD MCR
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	7907449	OTHER	FL	AETNA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801861299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL J MCKENNA MD

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	15761 NEW HAMPSHIRE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4176
Country	:	US
Telephone Number	:	239-415-8377
Fax Number	:	239-415-8770

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	04/18/2017

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