Provider Demographics
NPI:1043282759
Name:MACE, KEVIN WAYNE (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:WAYNE
Last Name:MACE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1208 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-3421
Mailing Address - Country:US
Mailing Address - Phone:641-828-3832
Mailing Address - Fax:641-828-3820
Practice Address - Street 1:1208 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3421
Practice Address - Country:US
Practice Address - Phone:641-828-3832
Practice Address - Fax:641-828-3820
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1043282759OtherNPI NUMBER
IA3440446Medicaid
IA5440446Medicaid
IAP00210325OtherRAILROAD MEDICARE
IA4440446Medicaid
IAI09107Medicare UPIN
IAI14006Medicare PIN