Active NPI
Michelle M McKane, MD
- Pediatrics Physician
- Southlake, TX
National Provider Identifier
1255363099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- M3640
- Practice address
- 2727 E Southlake Blvd
Southlake, TX 76092-6613 - Phone
- (682) 885-6000
- Fax
- (682) 885-6050
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | M3640 | TX | Primary |
| Emergency Medicine Physician | 207P00000X | M3640 | TX |
Addresses
Primary practice location
2727 E Southlake Blvd
Southlake, TX 76092-6613
Mailing address
PO Box 99213
Fort Worth, TX 76199-0213
Phone (682) 885-4871
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M3640 | TX | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326326400000",
"number": "1255363099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 99213",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761990213",
"telephone_number": "682-885-4871",
"fax_number": "682-885-3936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2727 E SOUTHLAKE BLVD",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926613",
"telephone_number": "682-885-6000",
"fax_number": "682-885-6050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKANE",
"first_name": "MICHELLE",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-06",
"last_updated": "2012-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "M3640",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "M3640",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.