Individual
MARK MCKINNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-S
Contact information
Practice address
750 HIGHLAND AVE # HSLC1270, MADISON, WI 53705-2221
(608) 263-5620
Mailing address
605 PARK ST, ANTIGO, WI 54409-2743
(715) 627-1111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
07/07/2020
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