Basic Information
| Provider Information | |||||||||
| NPI: | 1891008454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDYKE | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4439 STATE ROUTE 159 | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407797500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4439 STATE ROUTE 159 | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407797500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2010 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 34.010702 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.