Provider Demographics
NPI:1235209578
Name:MCKEE, MARK DENTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DENTON
Last Name:MCKEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2842 N BURLING ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6609
Mailing Address - Country:US
Mailing Address - Phone:773-325-9885
Mailing Address - Fax:773-834-4022
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 5031
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-2048
Practice Address - Fax:773-834-4022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH66138Medicare UPIN