Basic Information
| Provider Information | |||||||||
| NPI: | 1558368639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEMP | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 EASTWIND DR | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430813376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142689561 | ||||||||
| FaxNumber: | 6142687849 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 EASTWIND DR | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430813376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142689561 | ||||||||
| FaxNumber: | 6142687849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 09/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 350783296K | OH | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000000317275 | 01 | OH | ANTHEM PIN | OTHER | 64090350 | 05 | KY | MEDICAID | 310874776040 | 01 | OH | CARESOURCE | OTHER | 1194256 | 01 | OH | CIGNA PIN | OTHER | 2430257 | 05 | OH | MEDICAID | 4051609 | 01 | OH | AETNA PIN | OTHER |