Provider Demographics
NPI:1427053610
Name:CAYCE, KENNETH O IV (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:O
Last Name:CAYCE
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 OHIOHEALTH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43035
Practice Address - Country:US
Practice Address - Phone:740-615-0270
Practice Address - Fax:740-615-0279
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083557207QS0010X, 207Q00000X
OH35-083557207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2589319Medicaid
OH2589319Medicaid
I31787Medicare UPIN