Provider Demographics
NPI:1245384155
Name:MCKEE, MARGARET CRILE (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:CRILE
Last Name:MCKEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BROAD ST
Mailing Address - Street 2:SUITE 209A
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6786
Mailing Address - Country:US
Mailing Address - Phone:805-545-9015
Mailing Address - Fax:805-547-1395
Practice Address - Street 1:3000 BROAD ST
Practice Address - Street 2:SUITE 209A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6786
Practice Address - Country:US
Practice Address - Phone:805-545-9015
Practice Address - Fax:805-547-1395
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038430207RC0200X, 207RP1001X
CAG85886208M00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8254286Medicaid
CA11775376OtherCAQH ID#
CAG85886OtherCA MEDICAL LICENSE
CAG85886OtherCA MEDICAL LICENSE
CAAT964ZMedicare PIN
WA8254286Medicaid