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NPI Code Detail

MEDICARE: DR. PATRICK H MCKENNA MD

MEDICARE: DR. PATRICK H 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
1208800000XUrology Physician036103859IL
22088P0231XPediatric Urology Physician57335WI
32088P0231XPediatric Urology Physician036103859IL
4208800000XUrology Physician57335WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952397051
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK H MCKENNA MD
Provider Business Mailing Address
First Line : 8201 E RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-2300
Country : US
Telephone Number : 815-971-7255
Fax Number : 815-971-9955
Provider Business Practice Location Address
First Line : 8201 E RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-2300
Country : US
Telephone Number : 815-971-7255
Fax Number : 815-971-9955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 09/25/2020

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