Provider Demographics
NPI:1699768002
Name:KAY, DAVID I (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:I
Last Name:KAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2154
Mailing Address - Country:US
Mailing Address - Phone:616-754-9105
Mailing Address - Fax:616-754-9106
Practice Address - Street 1:1205 W OAK ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2154
Practice Address - Country:US
Practice Address - Phone:616-754-9105
Practice Address - Fax:616-754-9106
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43012054070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1983366Medicaid
0805910011Medicare ID - Type Unspecified
MI1983366Medicaid