Provider Demographics
NPI:1548243165
Name:MCGEHEE, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MCGEHEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:STE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:31022 TROUTDALE RIDGE RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7734
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME1047612085R0202X
TXH45372085R0202X
CODR.00316422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001477500Medicaid
FLH91987Medicare UPIN
FLCD140ZMedicare PIN
FLCD140OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
FLCD140YMedicare PIN