Healthcare Provider Details

I. General information

NPI: 1073818142
Provider Name (Legal Business Name): ERIC RICHARD KAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 EMERALD AVE NE
GRAND RAPIDS MI
49505-5227
US

IV. Provider business mailing address

1324 EMERALD AVE NE
GRAND RAPIDS MI
49505-5227
US

V. Phone/Fax

Practice location:
  • Phone: 616-560-2202
  • Fax:
Mailing address:
  • Phone: 616-560-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberK000234738741
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: