Healthcare Provider Details

I. General information

NPI: 1154345718
Provider Name (Legal Business Name): MITCHELL D KAYE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S MAIN ST
HOPKINSVILLE KY
42240-2009
US

IV. Provider business mailing address

1011 S MAIN ST
HOPKINSVILLE KY
42240-2009
US

V. Phone/Fax

Practice location:
  • Phone: 270-886-0470
  • Fax: 270-886-3802
Mailing address:
  • Phone: 270-886-0470
  • Fax: 270-886-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL D KAYE
Title or Position: OWNER
Credential: MD
Phone: 270-886-0470