Provider Demographics
NPI:1558003434
Name:MCKINNEY MEDICAL GROUP
Entity Type:Organization
Organization Name:MCKINNEY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS HEAD
Authorized Official - Prefix:
Authorized Official - First Name:SEHRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-440-2641
Mailing Address - Street 1:5900 S LAKE FOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2238
Mailing Address - Country:US
Mailing Address - Phone:214-440-2641
Mailing Address - Fax:214-440-2870
Practice Address - Street 1:5900 S LAKE FOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2238
Practice Address - Country:US
Practice Address - Phone:214-440-2641
Practice Address - Fax:214-440-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center