Provider Demographics
NPI:1972578177
Name:KAYE, MITCHELL D (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:D
Last Name:KAYE
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 1:1011 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-2009
Mailing Address - Country:US
Mailing Address - Phone:270-886-0470
Mailing Address - Fax:270-886-3802
Practice Address - Street 1:1011 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2009
Practice Address - Country:US
Practice Address - Phone:270-886-0470
Practice Address - Fax:270-886-3802
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25620207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64256209Medicaid
311488311OtherTIN
C67668Medicare UPIN
KY64256209Medicaid