Individual
MATTHEW JOHN MCKENNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
830 W DIVERSEY PKWY, CHICAGO, IL 60614-1454
(773) 248-4150
Mailing address
830 W DIVERSEY PKWY, CHICAGO, IL 60614-1454
(773) 248-4150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007973
IL
Other
Enumeration date
04/20/2020
Last updated
01/25/2021
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