DR. KENNETH J KAVANAUGH (DO) – Family Medicine Physician, NPI 1104819697

Family Medicine Physician

DR. KENNETH J KAVANAUGH (DO) is a healthcare provider. based in Sandwich, Illinois. specializing in Family Medicine Physician. They hold the professional credentials DO. They hold a License No. 036077591 (IL). The NPI Number for DR. KENNETH J KAVANAUGH (DO) is 1104819697

Main info

Male

39 Years Of Experience

Accepts Medicare Assignment

Name

DR. KENNETH J KAVANAUGH (DO)

NPI

1104819697

Phone

(815) 786-2722

Address

1 E COUNTYLINE RD

Enumeration Date

30 August 2005

Last Update Date

2 March 2021

Doctor Profile

Medical School Name

MIDWESTERN UNIVERSITY, CHICAGO COLLEGE OF OSTEOPATHIC MED

Secondary Phone

Graduation Year

1987 (39 years ago)

PAC ID

5092878710

Group Practice PAC ID

4284531484

Professional Enrollment ID

I20090107000164

Contacts

Secure Messaging

kkavanaugh14749@direct.edward.org

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience64

Completeness85

Years active:20State licenses:1Other namesUpdated within 12 months

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Provider Addresses for DR. KENNETH J KAVANAUGH (DO)

Countyline Road, Sandwich, DeKalb County, Illinois, 60548, United States
SANDWICH, IL 605482178
Phone: (815) 786-2722
Fax: (815) 786-6840
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60548)

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Provider's Procedures

DR. KENNETH J KAVANAUGH (DO) performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	IL	85610	Blood test, clotting time	152	18
FAMILY MEDICINE	IL	90670	Pneumococcal vaccine for injection into muscle	154	154

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 4284531484View full group profile

Name	Specialty	State
FARRUKH SALIM CHAUDHRY (MD)	Critical Care (Intensivists)	IL
DR. RICHARD W MASON (DO)	-	IL
CINDY BOHAC	-	IL
MEGAN RITA WILLS	-	IL
DR. FRANCINE L LONG (MD)	-	IL
ALEXANDER HANTEL (MD)	-	IL
VASANT R ACHARYA (M.D.)	-	IL
LISA STUCKY-MARSHALL (APN-CNS)	-	IL
DR. NOOSHIG LUZ SALVADOR (M.D.)	-	IL
CHRISTOPHER B. FERRON (P.A.)	Physician Assistant	IL

Reviews

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Frequently asked questions

How do payers reference DR. KENNETH J KAVANAUGH (DO)?

For DR. KENNETH J KAVANAUGH (DO), use NPI 1104819697 as the unique 10-digit identifier.

Is there an active status for DR. KENNETH J KAVANAUGH (DO)?

For scheduling context, DR. KENNETH J KAVANAUGH (DO) is shown as active in the registry.

What clinical focus is listed for DR. KENNETH J KAVANAUGH (DO)?

At a glance, DR. KENNETH J KAVANAUGH (DO) is tied to Family Medicine Physician. Clinical services aligned with this taxonomy classification.

Is DR. KENNETH J KAVANAUGH (DO) located near Sandwich?

DR. KENNETH J KAVANAUGH (DO) currently maps to Sandwich, Illinois in this extract.

Can I trust this NPI listing for DR. KENNETH J KAVANAUGH (DO)?

The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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