Provider Demographics
NPI:1023059599
Name:KAY, RANDY SCOTT
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SCOTT
Last Name:KAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24748 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2109
Mailing Address - Country:US
Mailing Address - Phone:313-278-1820
Mailing Address - Fax:313-278-8281
Practice Address - Street 1:24748 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2109
Practice Address - Country:US
Practice Address - Phone:313-278-1820
Practice Address - Fax:313-278-8281
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK009873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0158204284OtherBCBS OF MICH
MI4474096Medicaid
MA080H211350OtherBLUECARE NETWORK SE MICH
MI4474096Medicaid
MI5820428Medicare ID - Type Unspecified