MCKINLEY PETTY III (NPI# 1235231085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235231085 |
| Entity Type | Individual |
| Full Name | MCKINLEY PETTY III |
| Credential | M.D. |
| Practice Address |
2555 N Dr Martin Luther King Dr Milwaukee Health Services Inc Milwaukee WI 53212-2709 |
| Practice Telephone | 4143728080 |
| Mailing Telephone | 4143728080 |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2012-09-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 21443 | WI | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | 21443 | WI | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 21443 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 40950100 | 05 |
| Street Address |
2555 N DR MARTIN LUTHER KING DR MILWAUKEE HEALTH SERVICES INC |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53212-2709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558747352 | Christopher Derek Johnson | Pharmacist | 2555 N Dr Martin Luther King Dr, Milwaukee, WI 53212-2709 | 2015-08-04 |
| 1528483542 | Angelia Raychell Wilks-tate | Dietitian, Registered | 2555 N Dr Martin Luther King Dr, Milwaukee, WI 53212-2709 | 2014-02-27 |
| 1164853990 | Sara Doschadis Atteberry | Registered Nurse | 2555 N Dr Martin Luther King Dr, Milwaukee, WI 53212 | 2013-12-04 |
| 1043657505 | Richard Lightsey II | Dentist | 2555 N Dr Martin Luther King Dr, Milwaukee, WI 53212-2709 | 2013-05-23 |
| 1861626012 | Julie Joy Noel | Advanced Practice Midwife | 2555 N Dr Martin Luther King Dr, Milwaukee, WI 53212-2709 | 2009-05-02 |
| 1881892396 | Karen Mary Miller | Nutritionist | 2555 N Dr Martin Luther King Dr, Milwaukee Health Services Inc, Milwaukee, WI 53212-2709 | 2007-07-05 |
| 1316162217 | Cormac Kehoe | Pharmacist | 2555 N Dr Martin Luther King Dr, Pharmacy, Milwaukee, WI 53212-2709 | 2007-04-16 |
| 1518005818 | Milwaukee Health Services Inc | Clinic/Center | 2555 N Dr Martin Luther King Dr, Milwaukee, WI 53212-2709 | 2007-02-01 |
| 1861539421 | Carla Louise Wright | Physical Medicine & Rehabilitation | 2555 N Dr Martin Luther King Dr, Milwaukee Health Services Inc, Milwaukee, WI 53212-2709 | 2007-01-31 |
| 1104963784 | Michelle Natalie Dacosta | Dentist | 2555 N Dr Martin Luther King Dr, Milwaukee Health Services Inc, Milwaukee, WI 53212-2709 | 2007-01-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609481001 | Beth Leanna | Counselor | Benedict Center 1849 N Dr. Marin Luther King Dr., Suite 101, Milwaukee, WI 53212 | 2020-09-11 |
| 1326683749 | A.b.d.h. Counseling Services LLC | Clinic/Center | 518 E Concordia Avenue, Milwaukee, WI 53212 | 2019-11-08 |
| 1467095703 | Ifrah Hameed | Psychologist | 1849 N Doctor M.l.k. Jr Dr# 101, Milwaukee, WI 53212 | 2019-10-18 |
| 1386293330 | Rachel Mae Nelson Bagha | Student in an Organized Health Care Education/Training Program | 1849 N Doctor M.l.k. Jr Dr #101, Milwaukee, WI 53212 | 2019-09-11 |
| 1164085205 | Mary Sue Daase Bowen | Counselor | 2821 N 4th Street, Milwaukee, WI 53212 | 2019-04-15 |
| 1649733189 | Stacey King | Counselor | Rivershore Comprehensive Treatment Facility, 3703 N Richards St, Milwaukee Wi, Milwaukee, WI 53212 | 2019-04-11 |
| 1710447701 | Scott William Stauder | Student in an Organized Health Care Education/Training Program | 1121 E. North Ave., Milwaukee, WI 53212 | 2019-03-25 |
| 1821561168 | Lydia Ann Mendez | Counselor | 3703 N Richards St, Milwaukee, WI 53212 | 2019-01-09 |
| 1851863302 | Glen Victor Fleming | Counselor | 2821 North 4th Street Suite 210, Milwaukee, WI 53212 | 2018-12-21 |
| 1093285140 | Megan Marie Volp | Advanced Practice Midwife | 2555 N Doctor M.l.k. Jr Dr, Milwaukee, WI 53212 | 2018-12-03 |
| Find all providers in zip 53212 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730679804 | Vicki Milroy | Family Medicine | 2778 S 35th St Ste 102, Milwaukee, WI 53215-3578 | 2018-05-15 |
| 1376050450 | Independent Physicians of Wisconsin, LLC | Family Medicine | 5233 S 27th St, Milwaukee, WI 53221-3764 | 2018-01-10 |
| 1427565548 | Independent Physicians of Wisconsin, LLC | Family Medicine | 3201 S 16th St Ste 2020, Milwaukee, WI 53215-4532 | 2018-01-10 |
| 1962932970 | Mary Kuder | Family Medicine | 176 N Broadway, Milwaukee, WI 53202-6015 | 2017-06-13 |
| 1386178804 | Dane A Olsen | Family Medicine | 801 W Kinnickinnic River Pkwy., Suite 250, Milwaukee, WI 53215 | 2017-04-12 |
| 1598296212 | Leslie J Rabaut | Family Medicine | 2801 W Kk River Pkwy Ste 250, Milwaukee, WI 53215-3678 | 2017-03-23 |
| 1871975920 | Independent Physicians of Wisconsin, LLC | Family Medicine | 5434 W Capitol Dr Ste 3, Milwaukee, WI 53216-2298 | 2015-06-25 |
| 1952717928 | Mobile Medical Clinic, Inc | Family Medicine | 2418 W Edgerton Ave, Milwaukee, WI 53221-3412 | 2014-07-10 |
| 1437572831 | Pathfinder Medical Group | Family Medicine | 216 Milwaukee St, Suite 2d, Milwaukee, WI 53202 | 2014-01-22 |
| 1376897413 | Sandra Kathleen Mahkorn | Family Medicine | 3050 S Superior St, Milwaukee, WI 53207-3064 | 2012-10-26 |
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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.