| Phillip M. Mckean Professional Corporation | |
|
6605 E State Blvd Ste 7 Fort Wayne IN 46815-7036 | |
| (260) 486-2339 | |
| (260) 486-3219 |
| Full Name | Phillip M. Mckean Professional Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6605 E State Blvd Ste 7, Fort Wayne, Indiana |
| Authorized Official Name and Position | Vickey Ray Hullinger (OFFICE MANAGER) |
| Authorized Official Contact | 2604862339 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phillip M. Mckean Professional Corporation 6605 E State Blvd Ste 7 Fort Wayne IN 46815-7036 Ph: (260) 486-2339 | Phillip M. Mckean Professional Corporation 6605 E State Blvd Ste 7 Fort Wayne IN 46815-7036 Ph: (260) 486-2339 |
| NPI Number | 1699324103 |
|---|---|
| Provider Enumeration Date | 09/06/2019 |
| Last Update Date | 09/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699324103 | NPI | - | NPPES |
| 300028091 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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