Provider Demographics
NPI:1891008454
Name:VANDYKE, KENNETH W (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 STATE ROUTE 159
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8207
Mailing Address - Country:US
Mailing Address - Phone:740-779-7500
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:SUITE 150
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010702207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology