Healthcare Provider Details

I. General information

NPI: 1710977400
Provider Name (Legal Business Name): KEVIN WILLIAM KAMMLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SCIOTO TRL STE 200
PORTSMOUTH OH
45662-2845
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-8837
  • Fax: 740-353-7943
Mailing address:
  • Phone: 606-408-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34006652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: