Provider Demographics
NPI:1821061326
Name:MCKENNA, MICHAEL DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:MCKENNA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DELHI ST
Mailing Address - Street 2:STE 4100
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6358
Mailing Address - Country:US
Mailing Address - Phone:563-557-5900
Mailing Address - Fax:563-557-5905
Practice Address - Street 1:1500 DELHI ST
Practice Address - Street 2:STE 4100
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6358
Practice Address - Country:US
Practice Address - Phone:563-557-5900
Practice Address - Fax:563-557-5905
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1060969668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0108OtherJOHN DEERE HEALTH NUMBER
IA13252OtherDEANHEALTHCARE NUMBER
IA1821061326OtherNPI
IA55734OtherINDIVIDUAL WELLMARK NUMBE
IA2188276Medicaid
IA55321Medicare PIN
IA55734OtherINDIVIDUAL WELLMARK NUMBE