Provider Demographics
NPI:1093816753
Name:MURRAY-DREAD, KISHA D (DPM)
Entity Type:Individual
Prefix:DR
First Name:KISHA
Middle Name:D
Last Name:MURRAY-DREAD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13730 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2774
Mailing Address - Country:US
Mailing Address - Phone:302-563-4500
Mailing Address - Fax:
Practice Address - Street 1:13730 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2774
Practice Address - Country:US
Practice Address - Phone:248-629-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001881213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H249960OtherBLUE CROSS
MI4123036-13Medicaid
MI540H227720OtherBLUE CROSS SUPPLIER
MI5230860001OtherDME ADMINISTAR
MIP00155165OtherRAILROAD MEDICARE
MIU72887Medicare UPIN
MI0M93330Medicare ID - Type Unspecified