MEDICARE: MCKINNON MEDICAL GROUP, PLLC

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1841577541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKINNON MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	7575 W WASHINGTON AVE STE 127-160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4333
Country	:	US
Telephone Number	:	702-505-4230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 S CIMARRON RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7902
Country	:	US
Telephone Number	:	702-505-4230
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JONATHAN MCKINNON
Credential	:	MD
Telephone Number	:	702-256-3637

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	04/30/2024

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