JOHN MALCOLM MCKICHAN (NPI# 1548378367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548378367 |
| Entity Type | Individual |
| Full Name | JOHN MALCOLM MCKICHAN |
| Credential | M.D. |
| Practice Address |
11040 N State Road 77 Hayward WI 54843-6391 |
| Mailing Address |
16719w Sissabagama Rd Stone Lake WI 54876-8907 |
| Practice Telephone | 7159344321 |
| Mailing Telephone | 7158656406 |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
17740 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | LICENSE NUMBER | 17740 | 01 |
| WI | D.E.A. NUMBER | BM6733530 | 01 |
| Street Address |
11040 N STATE ROAD 77 |
| City | HAYWARD |
| State | WI |
| Zip Code | 54843-6391 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912992827 | Medical Services, Inc | General Acute Care Hospital | 11040 N State Road 77, Hayward, WI 54843-6391 | 2005-09-16 |
| 1962030320 | Constance M Kelsey | Speech-Language Pathologist | 11040 N State Road 77, Hayward, WI 54843-3606 | 2020-03-31 |
| 1255968418 | Kory Lutz | Physical Therapist | 11040 N State Road 77, Hayward, WI 54843-3606 | 2020-03-26 |
| 1881221059 | Erinn Greta Bratley | Occupational Therapist | 11040 N State Road 77, Hayward, WI 54843-3606 | 2020-03-26 |
| 1760034193 | Barbara L Bowman | Physician Assistant | 11040 N State Road 77, Hayward, WI 54843 | 2019-07-16 |
| 1003281809 | Ashland Audiology LLC | Clinic/Center | 11040 N State Road 77, Hayward, WI 54843-6391 | 2015-12-04 |
| 1497136428 | Andrea Yancey | Physician Assistant | 11040 N State Road 77, Hayward, WI 54843-3606 | 2015-06-16 |
| 1376954792 | Martha Krasean | Nurse Practitioner | 11040 N State Road 77, Hayward, WI 54843-3606 | 2014-05-20 |
| 1386055747 | Sarah Dums | Nurse Practitioner | 11040 N State Road 77, Hayward, WI 54843-3606 | 2014-05-19 |
| 1336405893 | Gregory Alan Lehman | Radiologic Technologist | 11040 N State Road 77, Hayward, WI 54843-6391 | 2012-04-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063011252 | Kelsey Eickstaedt | Pharmacist | 15594 State Hwy 77, Hayward, WI 54843 | 2020-10-20 |
| 1245687417 | Gary Girard | Counselor | 15655 W County Hwy B, Hayward, WI 54843 | 2016-05-18 |
| 1164844379 | Elizabeth Anne Johnson | Counselor | 10594 Main Street #1021, Hayward, WI 54843 | 2014-01-08 |
| 1376776922 | Amy Marilyn Billman | Massage Therapist | 11128n Highway 27/77, Hayward, WI 54843 | 2009-08-31 |
| 1700016516 | Kyra Rhodes Larson | Dentist | 15541w Hwy 77 East, Hayward, WI 54843 | 2009-07-15 |
| 1235383985 | Sara Jane Drost | Dental Hygienist | 15910 W Company Lake Road, Hayward, WI 54843 | 2008-11-07 |
| 1982856076 | Align Therapy,llc | In Home Supportive Care | 10767 Nyman Avenue, Hayward, WI 54843 | 2008-10-21 |
| 1316112477 | Michael John Larson | Hearing Instrument Specialist | 15612 Windrose Lane, #200, Hayward, WI 54843 | 2008-04-29 |
| 1679748966 | Gwendolyn Vinopal | Physical Therapist | 16014w Sleepy Hollow Drive, Hayward, WI 54843 | 2008-04-28 |
| 1558546523 | Ruth Anne Gillmor | Social Worker | 10610 Main, Hayward, WI 54843 | 2008-01-08 |
| Find all providers in zip 54843 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770182388 | Yalda Bahrani | Emergency Medicine | 27200 Calaroga Ave, Hayward, CA 94545-4383 | 2020-10-23 |
| 1245346626 | Christopher Wan | Emergency Medicine | 27400 Hesperian Blvd, Kaiser Hayward Emergency Dept., Hayward, CA 94545-4235 | 2006-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144703653 | Quinton Jarrett Peters | Emergency Medicine | 1204 S Jefferson St, Appleton, WI 54915-1726 | 2018-09-11 |
| 1497792139 | John A Culp | Emergency Medicine | 1446 N Randall Ave, Janesville, WI 53545-1122 | 2006-06-01 |
| 1861440505 | Alice C Bustos | Emergency Medicine | 7220 W National Ave, West Allis, WI 53214-4734 | 2006-05-05 |
| 1184690133 | Manuel A. Rivera | Emergency Medicine | 5000 Memorial Dr, Two Rivers, WI 54241-3900 | 2006-02-28 |
| 1942588132 | Watertown Regional Medical Center, Inc | Emergency Medicine | 125 Hospital Dr, Watertown, WI 53098-3303 | 2011-07-22 |
| 1366692287 | James John Macneal | Emergency Medicine | 1000 Mineral Point Ave, Janesville, WI 53548-2940 | 2008-09-28 |
| 1770646721 | Larry R Brunzlick | Emergency Medicine | 135 South Gibson Street, Medford, WI 54451 | 2006-12-19 |
| 1669563763 | Scott A Hathaway | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-27 |
| 1639279383 | Rajeshwar Hanmiah | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-23 |
| 1598863334 | George E Vidalakis | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-20 |
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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.