Provider Demographics
NPI:1104890623
Name:MILLER, KAY T (MD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:T
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAY
Other - Middle Name:SUZANNE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE #106
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-625-0300
Practice Address - Fax:248-625-0363
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010580722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102307OtherGREAT LAKES HEALTH PLAN - AOAM
MI4192919Medicaid
MI115615OtherCARE CHOICES HMO PROV. #
MI4253925Medicaid
MI102299OtherGREAT LAKES HEALTH PLAN - XRAY
MIG55448Medicare UPIN
MI4192919Medicaid
MI0E06288006Medicare PIN