Provider Demographics
NPI:1104861947
Name:MEKEEL, KRISTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:MEKEEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:LEIGH
Other - Last Name:MEKEEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 W ARBOR DR DEPT 8401
Mailing Address - Street 2:SUITE 2-280
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8401
Mailing Address - Country:US
Mailing Address - Phone:691-543-5870
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR DEPT 8401
Practice Address - Street 2:SUITE 2-280
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8401
Practice Address - Country:US
Practice Address - Phone:691-543-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90794208600000X
AZ35672204F00000X
CAC54096204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270663600Medicaid
AZ115142Medicaid
AZ860800150 85054 D001OtherTRICARE
AZP00625149OtherRAILROAD MEDICARE
FL48025Medicare ID - Type Unspecified
AZ115142Medicaid
FL270663600Medicaid