Provider Demographics
NPI:1164408852
Name:CAHILL, KENNETH VERN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:VERN
Last Name:CAHILL
Suffix:
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 1:262 NEIL AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7312
Mailing Address - Country:US
Mailing Address - Phone:614-221-7464
Mailing Address - Fax:614-221-8117
Practice Address - Street 1:262 NEIL AVE STE 430
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7312
Practice Address - Country:US
Practice Address - Phone:614-221-7464
Practice Address - Fax:614-221-8117
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.049318207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0558463Medicaid
OHCA0547814Medicare ID - Type Unspecified
OH0558463Medicaid