Individual
TODD O MCKINLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 N SENATE BLVD, SUITE 535, INDIANAPOLIS, IN 46202-1239
(317) 963-1950
(317) 963-1955
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01072035A
IN
207X00000X
Orthopaedic Surgery Physician
32992
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196949
—
IA
01
—
04528
WELLMARK BCBS
IA
05
—
200174490
—
IN
Enumeration date
09/12/2005
Last updated
01/15/2021
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