Provider Demographics
NPI:1225212285
Name:MCKINLEY, MARC R (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:R
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:STE T01
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-799-4224
Mailing Address - Fax:440-799-4228
Practice Address - Street 1:805 COLUMBIA RD STE 101
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1461
Practice Address - Country:US
Practice Address - Phone:216-228-5500
Practice Address - Fax:216-227-2628
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH58.002415207R00000X
OH34009847207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH66174Medicaid
OH66174Medicaid