Provider Demographics
NPI:1558364471
Name:MCKAY, THOMAS CONDON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CONDON
Last Name:MCKAY
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 1:3319 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2125
Mailing Address - Country:US
Mailing Address - Phone:563-359-1641
Mailing Address - Fax:563-359-4634
Practice Address - Street 1:3319 SPRING ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2125
Practice Address - Country:US
Practice Address - Phone:563-359-1641
Practice Address - Fax:563-359-4634
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085709208800000X
IA29811208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA340010198OtherMEDICARE RAILROAD
IL3110957Medicaid
IA0110957Medicaid
IA1346229192OtherNPI# UROLOGICAL ASSC PC
IL1346229192OtherNPI# UROLOGICAL ASSC PC
IL340016093OtherMEDICARE RAILROAD
IA16673Medicare ID - Type Unspecified
IL3110957Medicaid
IL336552Medicare PIN
IA07364Medicare PIN
IL1346229192OtherNPI# UROLOGICAL ASSC PC
IA1346229192OtherNPI# UROLOGICAL ASSC PC
IA0184500001Medicare NSC
ILL40112Medicare ID - Type Unspecified