Individual
DR. JEFFREY K MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 DEERPATH, CHARLESTON, IL 61920-9427
(217) 234-8000
(217) 234-8003
Mailing address
3024 E EMPIRE ST, SECOND FLOOR STE E & F, BLOOMINGTON, IL 61704-5402
(309) 451-3376
(309) 452-3376
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036-118958
IL
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
036.118958
IL
207NS0135X
Procedural Dermatology Physician
036-118958
IL
Other
Enumeration date
03/10/2006
Last updated
08/05/2019
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