Provider Demographics
NPI:1316960065
Name:MCKEE, MICHAEL SHANE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:MCKEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790256
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78279-0256
Mailing Address - Country:US
Mailing Address - Phone:210-545-0087
Mailing Address - Fax:210-545-3455
Practice Address - Street 1:20079 STONE OAK PKWY
Practice Address - Street 2:SUITE 1245
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-6942
Practice Address - Country:US
Practice Address - Phone:210-545-0087
Practice Address - Fax:210-545-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5046174400000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171244001Medicaid
TXL5046OtherLICENSE NUMBER
TX610640Medicare PIN