Healthcare Provider Details

I. General information

NPI: 1427053610
Provider Name (Legal Business Name): KENNETH O CAYCE IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OHIOHEALTH BLVD SUITE 200
DELAWARE OH
43035
US

IV. Provider business mailing address

5400 FRANTZ RD SUITE 250
DUBLIN OH
43016-4144
US

V. Phone/Fax

Practice location:
  • Phone: 740-615-0270
  • Fax: 740-615-0279
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35083557
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35-083557
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35083557
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: