MEDICARE: KENNETH IWUAFOR PA-C, CAQ-PSYCH

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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	50.004316RX	OH
2	202D00000X	Integrative Medicine Physician	50.004316RX	OH
3	363A00000X	Physician Assistant	50.004316RX	OH

General Provider Information

NPI Number	:	1609250273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH IWUAFOR PA-C, CAQ-PSYCH

Provider Business Mailing Address
First Line	:	2700 E DUBLIN GRANVILLE RD STE 300KK
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4094
Country	:	US
Telephone Number	:	614-284-3446
Fax Number	:	614-633-1534

Provider Business Practice Location Address
First Line	:	2700 E DUBLIN GRANVILLE RD STE 300KK
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4094
Country	:	US
Telephone Number	:	614-284-3446
Fax Number	:	614-633-1534

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	09/17/2025

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