Individual
MR. MARTIN JOHN MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9911 CORKSCREW ROAD, SUITE 101, ESTERO, FL 33928
(239) 768-2111
(239) 947-5007
Mailing address
12550 PROFESSIONAL PARK DRIVE, SUITE 11, FORT MYERS, FL 33913
(239) 768-2111
(239) 482-4404
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME66709
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376808200
—
FL
Enumeration date
05/01/2006
Last updated
08/14/2013
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