Provider Demographics
NPI:1427199058
Name:MCKHANN, GUY MEAD II (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:MEAD
Last Name:MCKHANN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W 168TH ST
Mailing Address - Street 2:NEUROLOGICAL INSTITUTE BOX 42
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3726
Mailing Address - Country:US
Mailing Address - Phone:212-305-0052
Mailing Address - Fax:212-305-3629
Practice Address - Street 1:710 W 168TH ST
Practice Address - Street 2:NEUROLOGICAL INSTITUTE BOX 42
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3726
Practice Address - Country:US
Practice Address - Phone:212-305-0052
Practice Address - Fax:212-305-3629
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212708207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01902592Medicaid
NYGM090E3910Medicare ID - Type Unspecified
NYG44523Medicare UPIN