Provider Demographics
NPI:1801861299
Name:MCKENNA, DANIEL J (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:15761 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4176
Practice Address - Country:US
Practice Address - Phone:239-415-8377
Practice Address - Fax:239-415-8770
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86932207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP952222OtherOPTIMUM
FLP305695OtherFREEDOM HEALTH
FL79175OtherBCBS OF FL
FL8379386OtherCIGNA
FL289239OtherAVMED
FL216438OtherWELLCARE (MEDICARE/MEDICAID)
FLP01283323OtherRAILROAD MCR
FL266705300Medicaid
FL7907449OtherAETNA
FL7907449OtherAETNA
FLP305695OtherFREEDOM HEALTH