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NPI Code Detail

MEDICARE: KAYLIE M RAY

MEDICARE: KAYLIE M RAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PS0010XSports Medicine (Emergency Medicine) Physician2400-53-1479IN

General Provider Information

NPI Number : 1629768411
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLIE M RAY
Provider Business Mailing Address
First Line : 7538 ARDWELL DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-9668
Country : US
Telephone Number : 317-945-6091
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3697
Country : US
Telephone Number : 317-788-3368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2023
Last Update Date : 05/15/2023

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Directions to “ KAYLIE M RAY ” Practice Location

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