DR. PATRICK H MCKENNA (NPI# 1952397051) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952397051 |
| Entity Type | Individual |
| Full Name | DR. PATRICK H MCKENNA |
| Credential | MD |
| Practice Address |
8201 E Riverside Blvd Rockford IL 61114-2300 |
| Practice Telephone | 8159717255 |
| Practice Fax Number | 8159719955 |
| Mailing Telephone | 8159717255 |
| Mailing Fax Number | 8159719955 |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-09-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208800000X | Urology | 036103859 | IL | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 57335 | WI | Allopathic & Osteopathic Physicians |
| Y | 2088P0231X |
Urology Specialization: Pediatric Urology |
036103859 | IL | Allopathic & Osteopathic Physicians |
| N | 2088P0231X |
Urology Specialization: Pediatric Urology |
57335 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1952397051 | 05 | |
| IL | 036103859 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3524 E Milwaukee St, Janesville, WI 535461626 | 6087567100 | 6087564700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831341601 | Patrick Mckenna | Skilled Nursing Facility | 84 Carriage Path S, South, Milford, CT 06460-7544 | 2008-10-10 |
| 1083812820 | Patrick Mckenna | General Practice | Comdesron 14, Medical Department, Fpo, AA 34099-4716 | 2007-07-03 |
| 1831358142 | Patrick A Mckenna | Family Medicine | 7102 Mineral Point Rd, Madison, WI 53717-1706 | 2008-06-03 |
| 1104851872 | Patrick James Mckenna | Radiology | 7500 Mercy Rd, Alegent Health Bergan Mercy Radiation Oncology, Omaha, NE 68124-2319 | 2006-07-11 |
| Street Address |
8201 E RIVERSIDE BLVD |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61114-2300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508865718 | Shobashalini Chokkalingam | Internal Medicine | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2005-07-19 |
| 1578190054 | Hyojin Jeon | Student in an Organized Health Care Education/Training Program | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2020-03-25 |
| 1043850068 | Lauren E Bell | Nurse Practitioner | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2020-01-07 |
| 1346898210 | Casandra Kay Pihl | Nurse Practitioner | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2019-09-03 |
| 1376196196 | Taha Mohamed Djirdeh | Student in an Organized Health Care Education/Training Program | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2019-07-21 |
| 1982256426 | Katrina Nicole Weir | Speech-Language Pathologist | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2019-07-15 |
| 1447802525 | Amit Johal | Student in an Organized Health Care Education/Training Program | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2019-07-10 |
| 1861055899 | Meghan Creath | Speech-Language Pathologist | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2019-04-16 |
| 1396207346 | Assem Miari | Physician Assistant | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2019-04-01 |
| 1043778772 | Rhonda J Gale | Nurse Practitioner | 8201 E Riverside Blvd, Rockford, IL 61114-2300 | 2019-03-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366064560 | Caleb Ifeoluwa Oluwadamisi | Student in an Organized Health Care Education/Training Program | Mercy Health Javon Bea Hospital, 8201 East Riverside Boulevard, Rockford, IL 61114 | 2020-05-11 |
| 1811525959 | Seifeldin Eid | Student in an Organized Health Care Education/Training Program | Mercyhealthjavon Bea Hospital, 8201, East Riversideboulevard, IL 61114 | 2020-04-01 |
| 1073167664 | Swedishamerican Hospital | Internal Medicine | 3505 N Bell School Road, Rockford, IL 61114 | 2019-07-31 |
| 1154980076 | Anurag Gill | Student in an Organized Health Care Education/Training Program | 8201 East Riverside Boulevard, Mercy Health Javon Bea Hospital, Rockford, IL 61114 | 2019-06-13 |
| 1578121943 | Sona Najafi | Student in an Organized Health Care Education/Training Program | Mercyhealth Javon Bea Hospital, 8201 East Riverside Blvd, Rockford, IL 61114 | 2019-05-31 |
| 1760045744 | Julianna Jones | Counselor | 6653 Weaver Rd Ste 115, Rockford, IL 61114 | 2019-04-16 |
| 1952869943 | Angela Marie Hawkins | Nurse Practitioner | 8201 E. Riverside Blvd, Pediatric Neurology, Rockford, IL 61114 | 2019-03-08 |
| 1376029231 | Meghan Beth Teske | Chiropractor | 3779 N. Alpine Rd., Rockfod, IL 61114 | 2018-07-13 |
| 1811401284 | Summit Radiology, LLC | Clinic/Center | 3849 N. Perryville Road, Rockford, IL 61114 | 2017-11-21 |
| 1548704299 | Rockford Orthopedic Associates, Ltd | Durable Medical Equipment & Medical Supplies | 5929 E Riverside Blvd, Rockford, IL 61114 | 2016-12-15 |
| Find all providers in zip 61114 | ||||
| Taxonomy Code | 2088P0231X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| Specialization | Pediatric Urology |
| Surgeons who can diagnose, treat, and manage children’s urinary and genital problems. A pediatric urologist devotes a minimum of 50% of his or her practice to the urologic problems of infants, children, and adolescents. Pediatric urologists generally provide the following services: the evaluation and management of voiding disorders; vesicoureteral reflux, and urinary tract infections that require surgery; surgical reconstruction of the urinary tract (kidneys, ureters, and bladder) including genital abnormalities, hypospadias, and intersex conditions; surgery for groin conditions in childhood and adolescence (undescended testes, hydrocele/hernia, varicocele). |
| Notes: Source: American Academy of Pediatrics [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578752739 | Kids Urology. S.c. | Urology | 2300 N Childrens Plz # 24, Chicago, IL 60614-3363 | 2007-10-23 |
| 1528109006 | Associated Urological Specialists LLC | Urology | 16632 107th St, Orland Park, IL 60467-8898 | 2007-02-09 |
| 1326189895 | Associated Urological Specialists | Urology | 4440 W 95th St Ste 109-112, Oak Lawn, IL 60453-2600 | 2007-02-09 |
| 1093892143 | John Houston | Urology | 2308 N Lincoln Ave, Chicago, IL 60614-3676 | 2006-11-01 |
| 1518983998 | Pediatric Urology Partners | Urology | 1440 Renaissance Dr, Suite 220, Park Ridge, IL 60068-1356 | 2006-07-15 |
| 1841844917 | Blair Mack | Urology | 1775 Dempster St, Park Ridge, IL 60068-1174 | 2019-07-28 |
| 1205126257 | Deborah Lynn Jacobson | Urology | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2011-04-12 |
| 1457675233 | Edward Ming-luan Gong | Urology | 225 E Chicago Ave, Box 24, Chicago, IL 60611-2991 | 2010-03-23 |
| 1558518761 | Jennifer Mickelson | Urology | 2300 N Childrens Plz # 24, Division of Urology - Childrens Memorial Hospital, Chicago, IL 60614-3363 | 2008-08-19 |
| 1316193824 | Derek John Matoka | Urology | 2160 S 1st Ave, Building 54, Maywood, IL 60153-3328 | 2008-08-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.