Provider Demographics
NPI:1760411599
Name:MCKENNA, JOSEPH P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 MERCY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1881
Mailing Address - Country:US
Mailing Address - Phone:231-733-1912
Mailing Address - Fax:231-737-4603
Practice Address - Street 1:1250 MERCY DR STE 101
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1881
Practice Address - Country:US
Practice Address - Phone:231-733-1912
Practice Address - Fax:231-737-4603
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016533207R00000X
MI4301090933207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I18041Medicare UPIN