MEDICARE: MR. RICHARD M KAY PA

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
1	363A00000X	Physician Assistant		IL

General Provider Information

NPI Number	:	1063497063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD M KAY PA

Provider Business Mailing Address
First Line	:	8858 S CRANDON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3027
Country	:	US
Telephone Number	:	773-731-7344
Fax Number	:	773-768-4119

Provider Business Practice Location Address
First Line	:	8858 S CRANDON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3027
Country	:	US
Telephone Number	:	773-731-7344
Fax Number	:	773-768-4119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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