Provider Demographics
NPI:1194763193
Name:MACY, KEVIN P (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:MACY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3250 MIDDLE URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9285
Mailing Address - Country:US
Mailing Address - Phone:937-399-7777
Mailing Address - Fax:937-399-6794
Practice Address - Street 1:7790 DAYTON SPRINGFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-1996
Practice Address - Country:US
Practice Address - Phone:937-340-6440
Practice Address - Fax:937-340-6441
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34008784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2671695OtherUNITEDHEALTHCARE
OH000000482599OtherANTHEM
OH7978819OtherAETNA
OH2666913Medicaid
OH2900159OtherCIGNA
OH4186951Medicare PIN
OHI56507Medicare UPIN