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General NPI Number Information
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NPI Number | 1427053610
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Entity Type | Individual
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Provider Name | KENNETH O CAYCE IV MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 801 OHIOHEALTH BLVD SUITE 200
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City | DELAWARE
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State | OH
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Zip | 43035
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Country | US
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Telephone | 740-615-0270
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Fax | 740-615-0279
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Provider Business Mailing Address
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Address Line | 5400 FRANTZ RD SUITE 250
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City | DUBLIN
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State | OH
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Zip | 43016-4144
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 35083557
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 35-083557
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35083557
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License Number State | OH
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