Provider Demographics
NPI:1427021989
Name:KEARNEY, MICHAEL MCLEAN (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MCLEAN
Last Name:KEARNEY
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 1:1431 PREMIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6076
Mailing Address - Country:US
Mailing Address - Phone:507-386-6600
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:1431 PREMIER DRIVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-386-6600
Practice Address - Fax:507-625-5971
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22389207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0901562OtherMEDICA, MANKATO
MN410940705H011OtherTRICARE/WPS
MN983181004372OtherPREFERRED ONE
MN120085C572OtherUCARE
MNHP18799OtherHEALTH PARTNERS
MN0900816OtherMEDICA, ST. PETER
MN0920985OtherMEDICA, ST. PETER HOSP
MN894295100Medicaid
MN41352KEOtherBCBS OF MN
MN907645OtherMEDICA, WASECA
MN0900816OtherMEDICA, ST. PETER
MN410940705H011OtherTRICARE/WPS
MND48693Medicare UPIN