Individual
DR. PATRICK H MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-7255
(815) 971-9955
Mailing address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-7255
(815) 971-9955
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
036103859
IL
208800000X
Urology Physician
57335
WI
2088P0231X
Pediatric Urology Physician
Primary
036103859
IL
2088P0231X
Pediatric Urology Physician
57335
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103859
—
IL
05
—
1952397051
—
WI
Enumeration date
09/23/2005
Last updated
09/25/2020
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