Provider Demographics
NPI:1285629758
Name:MCKINLEY, TODD O (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:O
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 535
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-963-1950
Practice Address - Fax:317-963-1955
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072035A207X00000X
IA32992207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0196949Medicaid
IN200174490Medicaid
IA04528OtherWELLMARK BCBS
IA200036558Medicare PIN
IN200174490Medicaid
IA0196949Medicaid
IA04528Medicare PIN
IA04528OtherWELLMARK BCBS