Healthcare Provider Details

I. General information

NPI: 1891775490
Provider Name (Legal Business Name): MARTIN STEPHEN KAYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 N 15TH AVE SUITE 104
PHOENIX AZ
85015-3328
US

IV. Provider business mailing address

5040 N 15TH AVE SUITE 104
PHOENIX AZ
85015-3328
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-9550
  • Fax: 602-263-1150
Mailing address:
  • Phone: 602-263-9550
  • Fax: 602-263-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: