MEDICARE: KEVIN WAYNE MACE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	3542	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00210325	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043282759	OTHER	IA	NPI NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043282759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WAYNE MACE DO

Provider Business Mailing Address
First Line	:	1208 N LINCOLN ST
Second Line	:
City	:	KNOXVILLE
State	:	IA
Zip	:	50138-3421
Country	:	US
Telephone Number	:	641-828-3832
Fax Number	:	641-828-3820

Provider Business Practice Location Address
First Line	:	1208 N LINCOLN ST
Second Line	:
City	:	KNOXVILLE
State	:	IA
Zip	:	50138-3421
Country	:	US
Telephone Number	:	641-828-3832
Fax Number	:	641-828-3820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	08/31/2022

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Directions to “ KEVIN WAYNE MACE DO” Practice Location

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