Provider Demographics
NPI:1740828698
Name:KEVIN KAMMLER DO LLC
Entity type:Organization
Organization Name:KEVIN KAMMLER DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMMLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-534-0154
Mailing Address - Street 1:199 HARTLEY RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8684
Mailing Address - Country:US
Mailing Address - Phone:937-534-0154
Mailing Address - Fax:937-534-0166
Practice Address - Street 1:199 HARTLEY RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8684
Practice Address - Country:US
Practice Address - Phone:937-534-0154
Practice Address - Fax:937-534-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2020851Medicaid